| NPI | 1235673898 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MUSTAFA HASSAN AHMED Director 952-220-9158 |
| Organization Subpart ? | No |
| Primary Taxonomy | 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child |
| Additional Taxonomies | 311ZA0620X Custodial Care Facility, Adult Care Home |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| Enumeration Date | 2016-12-15 |
| Last Update Date | 2016-12-15 |