| NPI | 1124317516 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IRVING BOONE Director 612-454-2340 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 302747) |
| Enumeration Date | 2011-04-06 |
| Last Update Date | 2011-04-12 |