| NPI | 1144301870 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA CAROL SECORE Program Coordinator/Family Based 218-751-3290 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: MN 893) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2020-08-22 |