| NPI | 1639851884 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SADIK A ALI Chief Manager 612-205-1113 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2023-08-07 |
| Last Update Date | 2023-10-11 |