| NPI | 1801169347 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHELLE NAOMI MOEN Owner 612-743-7788 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN LP2440) |
| Enumeration Date | 2012-02-14 |
| Last Update Date | 2012-02-14 |