| NPI | 1922295203 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID JAY MATHEWS Program Manager 952-646-6507 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN 13053) |
| Enumeration Date | 2007-10-01 |
| Last Update Date | 2017-05-05 |