| NPI | 1316652332 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUCKY IDA IGBINOBA CEO 763-723-1475 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251C00000X |
| Additional Taxonomies | 385H00000X Respite Care |
| Enumeration Date | 2023-01-16 |
| Last Update Date | 2023-01-16 |