| NPI | 1972008720 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN RICHARD JENSEN Counselor 712-363-5886 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 324500000X Substance Abuse Rehabilitation Facility | |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2018-03-26 |