| NPI | 1215005400 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENNIS E MEDVED President 218-245-1395 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: MN DHS1040263) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2020-08-22 |