| NPI | 1710005897 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID GLENN OLSON Owner CEO 952-920-2282 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN LP3475) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2020-08-22 |