| NPI | 1912877465 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEREK ERICKSON Owner/Treatment Director/Ladc 612-272-6978 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2025-11-10 |
| Last Update Date | 2025-11-10 |