| NPI | 1902113764 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY JOAN COOPER-SWENSON Administrator 218-454-0041 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2010-08-31 |
| Last Update Date | 2010-08-31 |