| NPI | 1407280720 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY M PETERSEN Partner 763-607-6874 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: MN 1066808-1-AFC) |
| Enumeration Date | 2013-08-22 |
| Last Update Date | 2013-08-22 |