| NPI | 1417623596 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER THOMAS JOHNSON Executive Director 612-386-8743 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility Adult Care Home |
| Enumeration Date | 2021-08-19 |
| Last Update Date | 2021-08-19 |