| NPI | 1508539727 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER DAWN DUCHSCHERER Senior Program Manager 651-302-7186 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2021-07-26 |
| Last Update Date | 2021-07-26 |