| NPI | 1588741292 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN E BROSE CEO 612-925-6033 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) (Licence: MN 811029-1-MHC) |
| Additional Taxonomies | 261QM0855X Clinic/Center Adolescent and Children Mental Health (Licence: MN 811029-1-MHC) |
| 261QM0850X Clinic/Center Adult Mental Health (Licence: MN 811029-1-MHC) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2018-09-06 |