| NPI | 1093190258 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTHONY SCOTT HOLMQUIST-BURKS Clinical Supervisor 612-827-0484 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: MN 303472) |
| Enumeration Date | 2015-07-29 |
| Last Update Date | 2015-07-29 |