| NPI | 1215104831 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JILL A WIEDEMANN-WEST CEO 651-774-0011 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2008-05-13 |
| Last Update Date | 2022-08-30 |