| NPI | 1376272088 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICHOLAS JERYL GOEDEL CEO 763-607-1120 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| Additional Taxonomies | 320700000X Residential Treatment Facility, Physical Disabilities |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| Enumeration Date | 2022-06-08 |
| Last Update Date | 2022-08-19 |