| NPI | 1245960442 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIN SIMONSON Owner 320-402-0115 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| 324500000X Substance Abuse Rehabilitation Facility | |
| 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children | |
| Enumeration Date | 2022-06-13 |
| Last Update Date | 2024-04-04 |