| NPI | 1902976764 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHERRY WAGNER CFO 320-589-4902 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 310500000X Intermediate Care Facility, Mental Illness (Licence: MN 802854-1-RS) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2011-03-18 |