| NPI | 1649984642 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATASHA R BENNETT Director 612-364-7592 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2023-01-13 |
| Last Update Date | 2023-01-13 |