| NPI | 1558931329 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROLYN J NIESCHE Director 612-521-4178 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2021-06-25 |
| Last Update Date | 2021-06-25 |