| NPI | 1982067559 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BONNI L HERPST Owner 612-910-8222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN 14922) |
| Enumeration Date | 2016-03-31 |
| Last Update Date | 2016-06-24 |