| NPI | 1467233759 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL OMOMO CEO 651-600-2567 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 251E00000X Home Health |
| 261QM0801X | |
| Enumeration Date | 2023-10-11 |
| Last Update Date | 2023-11-17 |