Organization
ANDREA RUDE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOEL OBERSTAR M.D. (CEO)
(763) 383-5800
Entity
Organization
Contact information
Practice address
12915 63RD AVE N, MAPLE GROVE, MN 55369-6001
(763) 383-5800
Mailing address
12915 63RD AVE N, MAPLE GROVE, MN 55369-6001
(763) 383-5800
Taxonomy
Speciality
Code
Description
License number
State
283Q00000X
Psychiatric Hospital
Primary
2284
MN
Other
Enumeration date
12/14/2011
Last updated
12/29/2011
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