| NPI | 1902302722 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH LONGFELLOW HANNA Owner 320-420-1272 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: MN 2571659) |
| Enumeration Date | 2018-04-02 |
| Last Update Date | 2025-02-05 |