| NPI | 1891152039 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FATHIA J WARSAME Management Official 651-756-1473 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: MN 1077275) |
| Enumeration Date | 2016-01-19 |
| Last Update Date | 2019-01-03 |