| NPI | 1063899953 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANN ELIZABETH WILSON Case Manager 612-454-2137 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2015-04-30 |
| Last Update Date | 2015-04-30 |