| NPI | 1952190290 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SABRINA MICHELLE FOULKS-THOMAS Owner 612-237-2746 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QC1500X Clinic/Center, Community Health | |
| Enumeration Date | 2025-05-03 |
| Last Update Date | 2025-05-03 |