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11670 Fountains Dr Suite 200 Maple Grove MN 55369 | |
| (760) 994-4990 | |
| (866) 899-8670 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 11670 Fountains Dr, Maple Grove, Minnesota |
| Authorized Official Name and Position | Iain Crabb (CFO/SECRETARY/ADMINISTRATOR) |
| Authorized Official Contact | 7609944990 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
911 Lakeville St # 322 Petaluma CA 94952-3329 Ph: (760) 994-4990 | 11670 Fountains Dr Suite 200 Maple Grove MN 55369 Ph: (760) 994-4990 |
| NPI Number | 1568817542 |
|---|---|
| Provider Enumeration Date | 04/27/2016 |
| Last Update Date | 11/07/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568817542 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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