| NPI | 1083904239 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN MERLADET Presedent 612-532-1128 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN 5290) |
| Enumeration Date | 2011-04-08 |
| Last Update Date | 2011-04-08 |