National Provider Identifier Database

RED LAKE AVIVO SUD TRIBAL HEALTH SERVICES
Substance Abuse Disorder Rehabilitation Facility

A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.


Contact Information

RED LAKE AVIVO SUD TRIBAL HEALTH SERVICES
1900 CHICAGO AVE S
MINNEAPOLIS, MN55404
Phone: 612-752-8106
Fax:
Website:
Specialty Taxonomy Code
* Substance Abuse Disorder Rehabilitation Facility 324500000X

* Indicates primary specialty

NPI Profile & details for RED LAKE AVIVO SUD TRIBAL HEALTH SERVICES

NPI Number 1740042654
Legal business name
LBN
RED LAKE AVIVO SUD TRIBAL HEALTH SERVICES
Authorized official CHARLENE ANDERSEN - (REVENUE MANGER)
Entity Organization
Organization subpart No
Enumeration date 01/25/2024
Last updated 01/25/2024 - About 2 years ago
Sole proprietor1 Not specified
Identifiers n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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