| NPI | 1184017279 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YUSSUF SHAFIE Executive Director 952-992-9803 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: MN 1077449) |
| Enumeration Date | 2015-03-12 |
| Last Update Date | 2015-03-12 |