| NPI | 1962585869 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD JOSEPH OBERSHAW Director 612-867-4866 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN 0753) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2020-08-22 |