| NPI | 1407356710 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MOLLY CORENE PENA Owner 320-252-6017 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MN 00597) |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2018-02-14 |
| Last Update Date | 2019-04-01 |