| NPI | 1144950460 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HUNTER VALENTINE-JOHNSTON Owner 651-206-0183 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2022-06-10 |
| Last Update Date | 2022-06-10 |