| NPI | 1639861081 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICIA DENNIS Chief Executive Officer 763-204-8541 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2023-05-24 |
| Last Update Date | 2023-05-24 |