| NPI | 1588100739 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANN JOHNSON Director 218-287-2089 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN 300070) |
| Enumeration Date | 2017-01-12 |
| Last Update Date | 2017-01-12 |