RED LAKE CHEMICAL HEALTH PROGRAMS; NPI #1578070991

Contact Information

RED LAKE CHEMICAL HEALTH PROGRAMS

15566 DAKOTA AVENUE
REDBY, MN 56670

Phone: 218-679-3387
Fax: 218-679-2375
Website:

Specialty	Taxonomy Code	Specialty Code	Provider Type
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy	332800000X	87	All Other Suppliers
Substance Abuse Disorder Rehabilitation Facility	324500000X

Indicates primary specialty

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NPI Profile & details for RED LAKE CHEMICAL HEALTH PROGRAMS

NPI Number 1578070991

LBN Legal business name RED LAKE CHEMICAL HEALTH PROGRAMS

Authorized official REYNA GONZALEZ-RIVERA - (PROJECT DIRECTOR)

Entity Organization

Organization subpart ¹ No

Enumeration date 01/08/2018

Last updated 03/20/2019 - About 7 years ago

Identifiers

Medicaid

649755100

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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