| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 42293 Twilight Rd, Onamia, Minnesota |
| Authorized Official Name and Position | Nicole Anderson (COMMISSIONER OF HEALTH & HUMAN SERV) |
| Authorized Official Contact | 3205324163 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
18562 Minobimaadizi Loop Onamia MN 56359-3001 Ph: (320) 532-4163 | 42293 Twilight Rd Onamia MN 56359 Ph: (320) 532-5292 |
| NPI Number | 1831388909 |
|---|---|
| Provider Enumeration Date | 10/15/2007 |
| Last Update Date | 07/21/2022 |
| Certification Date | 10/14/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831388909 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (Minnesota) | Primary |
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