| NPI | 1952831026 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MOHAMED MOHAMED Owner/Manager 651-788-9231 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2017-06-12 |
| Last Update Date | 2018-08-02 |