| NPI | 1609276724 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON FISCHER Manager 952-426-6219 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: MN 1066119) |
| Enumeration Date | 2014-08-26 |
| Last Update Date | 2014-08-26 |