| NPI | 1124762117 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA KING President 651-428-9045 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 276400000X Rehabilitation, Substance Use Disorder Unit |
| Enumeration Date | 2022-04-25 |
| Last Update Date | 2024-03-15 |