| NPI | 1982572533 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERARTU YISHAK Administrator 612-202-9281 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2025-10-27 |
| Last Update Date | 2025-10-27 |