| NPI | 1639859242 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELECHI BLANTON Owner 612-235-9988 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2023-07-19 |
| Last Update Date | 2023-08-23 |