| NPI | 1396984530 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA A RUSTAD Owner 612-708-1401 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 252Y00000X Early Intervention Provider Agency |
| Enumeration Date | 2009-02-11 |
| Last Update Date | 2009-12-08 |