| NPI | 1528304136 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA EHNES Administrator 218-721-4732 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy |
| 261QR0400X Clinic/Center, Rehabilitation | |
| Enumeration Date | 2012-12-31 |
| Last Update Date | 2019-04-06 |