| NPI | 1194278655 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNA KAREN LUDOWESE Credentialing 320-364-1314 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: MN 1080843) |
| Additional Taxonomies | 251S00000X |
| 261Q00000X Clinic/Center | |
| Enumeration Date | 2016-08-01 |
| Last Update Date | 2024-09-20 |