| NPI | 1124769930 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA RICHIO Authorized Official 952-251-2987 |
| Organization Subpart ? | No |
| Primary Taxonomy | 171400000X |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2024-06-10 |