| NPI | 1740971670 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENARD CHESSUM Provider 612-406-0088 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2023-05-19 |
| Last Update Date | 2023-05-19 |