| NPI | 1295240265 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY MICHAEL WELSH Director Of Services 952-303-3489 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2017-12-12 |
| Last Update Date | 2017-12-12 |