| NPI | 1700959939 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAN JOHNSON Director 218-894-0034 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children (Licence: MN 1002834) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2008-07-23 |