| NPI | 1164875670 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | INEZ BERSIE-MIZE Director 651-249-9749 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN 1106) |
| Enumeration Date | 2016-07-20 |
| Last Update Date | 2016-07-20 |