| NPI | 1992795280 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALICE JOHNSON CFO 763-520-0206 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0401X Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) (Licence: MN 8356799) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MN 8356799) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MN 8356799) | |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2007-07-13 |