| NPI | 1073201836 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW SALVATORE EMERSON Executive Director 612-401-4864 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0800X Clinic/Center, Recovery Care |
| Enumeration Date | 2023-04-28 |
| Last Update Date | 2023-04-28 |