| NPI | 1538198361 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY BOURQUIN Administation Coordinator 507-376-3550 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: MN 1021018-1-WS) |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: MN 1021018-1-WS) |
| Enumeration Date | 2006-07-02 |
| Last Update Date | 2020-08-22 |