| NPI | 1720406168 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARCUS BLUE Operations Officer 952-451-8160 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2018-09-25 |