| NPI | 1841441037 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MYRON IMRI WELTY Owner 763-753-9884 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: MN 1080415-1-HCBS) |
| Enumeration Date | 2008-10-06 |
| Last Update Date | 2016-08-03 |