| NPI | 1922683549 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORRIS MICHAEL MBABAZI Owner 320-266-7514 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2021-03-15 |
| Last Update Date | 2021-03-15 |