| NPI | 1679977045 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BLAKE ELLIOTT Owner 612-695-6041 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: MN 1050628-3-AFC) |
| Enumeration Date | 2014-10-14 |
| Last Update Date | 2014-10-14 |