| NPI | 1720693146 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HIBAQ A DUALEH Operation Manager 651-528-1065 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2020-09-11 |
| Last Update Date | 2020-09-11 |