| NPI | 1992179386 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BARBARA MAE NELSON Program Director 218-844-5788 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2015-11-23 |
| Last Update Date | 2015-11-23 |