| NPI | 1598863615 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE LEE REID Administrator 612-379-4027 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311Z00000X Custodial Care Facility (Licence: MN 636054900) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2021-05-17 |