| NPI | 1164881561 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS JOHNSON President 218-302-4468 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: MN CNP 2950) |
| Enumeration Date | 2016-02-15 |
| Last Update Date | 2016-04-13 |