| NPI | 1154839660 |
|---|---|
| Doing Business As | SOUTHDALE ADDICTION CLINIC |
| Doing Business As | DR. GREEN |
| Entity Type | Organization |
| Authorized Contact | CODY W WENDLANDT Medical Director 320-200-9547 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Enumeration Date | 2018-01-18 |
| Last Update Date | 2018-06-16 |