| NPI | 1770024978 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY LARSEN KUSS Director 651-208-1231 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN 1482) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: MN 301198) |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2017-03-20 |