| NPI | 1992152821 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID BACKUS Executive Director 651-252-6070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 303683) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 303672) | |
| 101YP2500X Counselor, Professional (Licence: MN 1204) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 304003) | |
| Enumeration Date | 2016-05-20 |
| Last Update Date | 2020-03-11 |