| NPI | 1164290326 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SILAS HARRIS Owner 952-666-9915 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 251S00000X |
| 261QM2800X Clinic/Center, Methadone Clinic | |
| Enumeration Date | 2023-12-18 |
| Last Update Date | 2023-12-18 |