| NPI | 1467136895 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ABDIRAHMAN SHARIFF OMAR Administrator 612-999-8057 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2023-06-14 |
| Last Update Date | 2023-06-14 |