| NPI | 1245397959 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLEY GIBSON VP Payer Relations 651-213-4519 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: IL A-9403-0001-P) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2025-05-16 |