| NPI | 1225429087 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW GORDON JOHNSON Residential Counselor 651-307-2486 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3104A0625X Assisted Living Facility Assisted Living, Mental Illness |
| Enumeration Date | 2015-02-13 |
| Last Update Date | 2015-02-13 |