| NPI | 1851872832 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RITA AGHENTA Administrator 651-955-6535 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Additional Taxonomies | 3104A0630X Assisted Living Facility, Assisted Living, Behavioral Disturbances (Licence: AZ BH5499) |
| Enumeration Date | 2018-08-27 |
| Last Update Date | 2021-06-28 |