| NPI | 1235805615 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEREK JOHN ERICKSON Owner, Treatment Director 612-272-6978 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2021-08-17 |
| Last Update Date | 2021-08-17 |