BLACK VINE LLC
Organization (NPI-2)
Active
Case Management
Provider Information
- NPI Number
1326359159- Provider Type
- Organization / Facility (NPI-2)
- Status
- Active
Contact & Location
- Address
- 4445 W 77TH ST SUITE 122, EDINA, MN, 554355133
- Phone
- (952) 960-2266
- Fax
- (952) 960-2267
Specialties & Taxonomies
Case Management
Primary License: MN #348111