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General NPI Number Information
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NPI Number | 1801596796
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Entity Type | Organization
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Legal Business Name | C E SOMLAI LLC
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Dates
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Enumeration Date | 03/08/2023
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Last Update Date | 03/08/2023
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Provider Practice Location Address
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Address Line | 12401 MINNETONKA BLVD
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City | MINNETONKA
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State | MN
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Zip | 55305-3971
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Country | US
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Telephone | 952-529-8981
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Fax |
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Provider Business Mailing Address
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Address Line | 1554 LIBERTY CIR
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City | SHAKOPEE
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State | MN
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Zip | 55379-4545
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Country | US
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Telephone | 612-868-4967
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Fax |
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Authorized Official
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Title or Position | OWNER, DIRECTOR
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Name | CORY EDWARD SOMLAI
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Credential |
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Telephone | 952-529-8981
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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