| NPI | 1558652925 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CONNIE BOMBENGER Director 651-489-7740 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children (Licence: MN 301767) |
| Enumeration Date | 2011-04-20 |
| Last Update Date | 2011-04-20 |