| NPI | 1174995146 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DELORR PICKERING President 218-428-2251 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: WI 8063-123) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: MN 12371) |
| Enumeration Date | 2015-10-29 |
| Last Update Date | 2015-10-29 |