Organization
LIBRA SUPPORT SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACY LYNN LUNS (PRESIDENT/OWNER)
(651) 402-9826
Entity
Organization
Contact information
Practice address
29650 FAITH CT, CANNON FALLS, MN 55009-9439
(651) 402-9826
(651) 402-9826
Mailing address
29650 FAITH CT, CANNON FALLS, MN 55009-9439
(651) 402-9826
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
1041897-1-WS
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
637683500
MN HEALTH CARE PROV-MHCP
MN
Enumeration date
10/09/2006
Last updated
07/21/2022
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