| NPI | 1932468683 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NANCY J RACH Counselor 218-640-1992 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center Adult Mental Health (Licence: MN CC00293) |
| Additional Taxonomies | 282NC0060X General Acute Care Hospital Critical Access (Licence: MN CC00293) |
| 302R00000X Health Maintenance Organization (Licence: MN CC00293) | |
| Enumeration Date | 2012-05-15 |
| Last Update Date | 2012-05-15 |