| NPI | 1336658277 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBRA RAE WARNER Billing Manager 612-238-6528 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2017-09-22 |
| Last Update Date | 2022-03-14 |