| NPI | 1285057539 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL WILLIAM MAHONEY Treatment Director 507-218-3450 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 302F00000X Exclusive Provider Organization | |
| Enumeration Date | 2014-01-22 |
| Last Update Date | 2022-03-14 |