| NPI | 1659534725 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIA DUBAK Medical Billing Manager 651-286-8613 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251B00000X Case Management |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| 311ZA0620X Custodial Care Facility, Adult Care Home | |
| 251S00000X Community/Behavioral Health | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2025-10-20 |