| NPI | 1285400606 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RACHEL JEAN BACKLUND Owner 612-478-8040 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2023-11-27 |
| Last Update Date | 2023-11-27 |