| NPI | 1477821791 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARAH GRILL Office Manager 952-548-9340 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2011-12-01 |
| Last Update Date | 2011-12-01 |