| NPI | 1396839148 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT BLAKE LENNARTSON Owner 651-458-0813 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320700000X Residential Treatment Facility, Physical Disabilities (Licence: MN 235363-2-AFC) |
| Additional Taxonomies | 311ZA0620X Custodial Care Facility Adult Care Home (Licence: MN 235363-4-AFC) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2008-09-08 |