| NPI | 1215528161 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYLE D HANSON Executive Director 612-874-0311 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2021-02-02 |
| Last Update Date | 2023-06-05 |