| NPI | 1770248577 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEB LANE-OLSON Sole Owner 320-260-4184 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2021-11-05 |
| Last Update Date | 2021-11-05 |