| NPI | 1891588034 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAULINE MARIE NOVAK Clinical Coordinator 612-261-8849 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2025-05-28 |
| Last Update Date | 2025-08-22 |