| NPI | 1700279924 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROLYN LARSON Supervisor 651-771-1301 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN 2351) |
| Enumeration Date | 2015-03-12 |
| Last Update Date | 2015-03-12 |