| NPI | 1518053834 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYNN VAN BLARCUM Managing Director 952-938-2600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN 7571675) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2018-11-16 |