| NPI | 1831329564 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY SHEA JONES President 612-501-6807 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: MN 18233) |
| Additional Taxonomies | 261QC1500X Clinic/Center, Community Health |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2009-07-15 |
| Last Update Date | 2022-07-15 |