Individual
JACOB WRICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
603 3RD ST W APT 1, HASTINGS, MN 55033-1127
(651) 319-0193
Mailing address
603 3RD ST W, HASTINGS, MN 55033-1127
(651) 434-0449
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
1097171
MN
Other
Enumeration date
11/21/2018
Last updated
11/21/2018
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