| NPI | 1871931535 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY THOMPSON Director 651-488-0601 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: MN 1065490) |
| Enumeration Date | 2013-06-04 |
| Last Update Date | 2013-06-04 |