| NPI | 1871641373 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THERESE G DAVIS Executive Director 651-242-5840 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: MN HFID 01198) |
| Additional Taxonomies | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: MN HFID 01287) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2019-06-24 |