| NPI | 1629117452 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY JON JOHNSON Program Cooridanator 651-633-4532 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: MN 820357100) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2008-04-28 |