| NPI | 1174783872 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER JEAN MACDOUGALL Program Director 651-788-2751 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN 1045950) |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2008-06-16 |