| NPI | 1700450426 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHONDELL GANTZER Office Manager 701-857-4232 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2021-05-17 |
| Last Update Date | 2021-05-17 |