| NPI | 1467774307 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLEY GIBSON VP Payer Relations 651-213-4519 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2010-02-19 |
| Last Update Date | 2025-05-16 |