| NPI | 1215694500 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY C IWEAJUNWA Manager 763-442-0749 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2021-11-21 |
| Last Update Date | 2021-11-21 |