| NPI | 1861990459 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FARDOWSA ALI CEO 952-454-0421 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QD1600X Clinic/Center, Developmental Disabilities |
| 261QR0400X Clinic/Center, Rehabilitation | |
| Enumeration Date | 2018-01-29 |
| Last Update Date | 2024-01-23 |