| NPI | 1780103929 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRYAN JOHNSON Owner 612-930-2265 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN 1086810) |
| Additional Taxonomies | 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 253Z00000X In Home Supportive Care | |
| 310400000X Assisted Living Facility | |
| Enumeration Date | 2017-09-19 |
| Last Update Date | 2026-03-20 |