| NPI | 1760892244 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARA LEMKE EBENHOCH Owner 763-228-4752 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN 1939) |
| Enumeration Date | 2014-05-05 |
| Last Update Date | 2014-05-05 |