| NPI | 1962721175 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONY NELSON Manager Accts Rec 651-438-4363 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 251K00000X Public Health or Welfare |
| Enumeration Date | 2010-05-27 |
| Last Update Date | 2014-08-25 |