| NPI | 1528360591 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE BEAULIEU Insurance Representative 763-257-5301 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization (Licence: MN 1056824-1-CDT) |
| Enumeration Date | 2010-11-24 |
| Last Update Date | 2022-03-14 |