| NPI | 1952463382 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN ANTHONY LORAAS Treasurer 952-432-3220 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2020-08-22 |