| NPI | 1225676067 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LILIANA KIGONYA Medical Director 651-300-4355 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261Q00000X |
| 261QM1000X Clinic/Center, Migrant Health | |
| 261QM1102X Clinic/Center, Military Outpatient Operational (Transportable) Component | |
| 251B00000X Case Management | |
| 251G00000X Hospice Care, Community Based | |
| 261QM2800X Clinic/Center, Methadone Clinic | |
| 253Z00000X In Home Supportive Care | |
| 261QP2400X Clinic/Center, Prison Health | |
| 261QU0200X Clinic/Center, Urgent Care | |
| 310400000X Assisted Living Facility | |
| 314000000X Skilled Nursing Facility | |
| 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| Enumeration Date | 2019-12-11 |
| Last Update Date | 2019-12-11 |