| NPI | 1487250809 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MOHAMMED KANNEH Vice President 763-318-5371 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| Additional Taxonomies | 320600000X Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| 320700000X Residential Treatment Facility, Physical Disabilities | |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| Enumeration Date | 2020-12-10 |
| Last Update Date | 2024-04-15 |