| NPI | 1073077459 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMATER MAHAMOUD President 952-236-7411 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2019-01-30 |
| Last Update Date | 2019-06-12 |