| NPI | 1992870679 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORI KRESS CEO 651-699-0206 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: OK 100631340H) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2023-04-27 |