Organization
NIRVANA NORTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATTHEW RYAN MOORE (OWNER)
(218) 343-7734
Entity
Organization
Contact information
Practice address
503 HOWARD GNESEN RD, DULUTH, MN 55811-1614
(218) 343-7734
Mailing address
503 HOWARD GNESEN RD, DULUTH, MN 55811-1614
(218) 343-7734
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
06/18/2024
Last updated
06/18/2024
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