| NPI | 1558453704 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN G. LIETHEN Secretary 952-205-6262 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: CA PSY 21006) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: CA PSY 21006) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2019-09-16 |