| NPI | 1790818078 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOAN MATHEWS LARSON Owner 612-827-7800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: MN 801006-2-CDT) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2010-11-18 |