| NPI | 1801161427 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERRYCK VANCURK MOORE CEO 612-220-8645 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: MN 301674) |
| Enumeration Date | 2012-03-14 |
| Last Update Date | 2012-03-14 |