| NPI | 1154626554 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORI ZOOK Controller 651-431-3691 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: MN 1058768-1-RMI) |
| Enumeration Date | 2011-01-14 |
| Last Update Date | 2011-01-14 |