| NPI | 1073928701 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RHONDA EAVES Office & Finance Manager 651-225-8997 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN LP0061) |
| Enumeration Date | 2014-06-20 |
| Last Update Date | 2014-06-20 |