| NPI | 1619722675 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHRYN (KATIE) A WAGNER President 320-905-6152 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2024-04-22 |
| Last Update Date | 2024-04-22 |