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Organization
REFRACTIONS LLC
Active
Organization
REFRACTIONS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MOLLY CORENE PENA (OWNER)
(320) 252-6017
Entity
Organization
Contact information
Practice address
22575 43RD AVE, SAINT AUGUSTA, MN 56301-8729
(320) 223-1161
Mailing address
22575 43RD AVE, SAINT AUGUSTA, MN 56301-8729
(320) 223-1161
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
00597
MN
320800000X
Mental Illness Community Based Residential Treatment Facility
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Other
Enumeration date
02/14/2018
Last updated
04/01/2019
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