| NPI | 1992349856 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NANCY GAVIN Assistant Secretary/Assistant Treas 612-428-7840 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251T00000X PACE Provider Organization |
| Enumeration Date | 2019-11-04 |
| Last Update Date | 2022-03-09 |