| NPI | 1992548739 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW RYAN MOORE Owner 218-343-7734 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2024-06-18 |
| Last Update Date | 2024-06-18 |