| NPI | 1659627347 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COLLEEN PRUDHOMME Executive Director 763-566-0088 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN 20478) |
| Enumeration Date | 2012-07-31 |
| Last Update Date | 2012-07-31 |