| NPI | 1609154178 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORI A ZOOK Controller 651-431-3691 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: MN 353355) |
| Enumeration Date | 2011-08-01 |
| Last Update Date | 2011-08-01 |