| NPI | 1376258673 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARLETTE RENEE ANDERSON CEO 218-460-9095 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2023-01-20 |
| Last Update Date | 2023-01-20 |