| NPI | 1346633955 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALLEN JEROME JOHNSON CEO 952-484-5401 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN 1076645-1-CDT) |
| Enumeration Date | 2015-03-07 |
| Last Update Date | 2015-03-07 |