| NPI | 1861764078 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER S JOHNSON Owner 763-400-7475 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN 1951) |
| Enumeration Date | 2012-02-02 |
| Last Update Date | 2024-01-09 |