Organization
SUNFLAKE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB DEVNEY (OWNER)
(612) 730-7955
Entity
Organization
Contact information
Practice address
6525 CENTRAL AVE NE UNIT 2, FRIDLEY, MN 55432-4653
(612) 730-7955
Mailing address
6525 CENTRAL AVE NE UNIT 2, FRIDLEY, MN 55432-4653
Taxonomy
Speciality
Code
Description
License number
State
320700000X
Physical Disabilities Residential Treatment Facility
Primary
EA657799
MN
Other
Enumeration date
08/29/2014
Last updated
08/29/2014
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