| NPI | 1407292386 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIE BERNARD GARRETT CEO 651-646-8594 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN LP1234) |
| Enumeration Date | 2013-05-17 |
| Last Update Date | 2013-05-17 |