| NPI | 1144725623 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN ANTHONY DELONG Clinical Director 651-454-6118 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2018-03-27 |
| Last Update Date | 2018-10-07 |