NPI | 1962408906 |
---|---|
Entity Type | Organization |
Authorized Contact | JAMES PLATTEN CEO 651-290-9245 |
Organization Subpart ? | Yes |
Primary Taxonomy | 261QC1500X Clinic/Center, Community Health |
Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: MN 052730) |
Enumeration Date | 2005-06-23 |
Last Update Date | 2017-12-08 |