| NPI | 1366959967 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONYA BERTEEN BLAIR-TISCHER Owner 218-651-0212 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: MN 1090064) |
| Enumeration Date | 2018-01-04 |
| Last Update Date | 2018-01-04 |