| NPI | 1215569678 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON REED Owner 763-577-2489 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2020-02-04 |
| Last Update Date | 2021-10-02 |