| NPI | 1295979664 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH I SHAGALOW Owner/Officer 952-831-3662 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: MN LP4413) |
| Enumeration Date | 2009-04-28 |
| Last Update Date | 2009-04-28 |