| NPI | 1114292356 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEENA M MCMAHON Owner 651-210-0335 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN 2318) |
| Enumeration Date | 2012-03-21 |
| Last Update Date | 2012-03-21 |