| NPI | 1164255733 | 
|---|---|
| Entity Type | Organization | 
| Authorized Contact | PRINCESS GEHYIGON WALLACE Owner 763-913-8125 | 
| Organization Subpart ? | No | 
| Primary Taxonomy | 252Y00000X Early Intervention Provider Agency | 
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services | 
| Enumeration Date | 2024-08-20 | 
| Last Update Date | 2025-06-23 |