| NPI | 1497608814 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MUBARIG H JAMA Owner 952-683-0976 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2026-02-16 |
| Last Update Date | 2026-02-16 |