Leech Lake Opiate Treatment Program

NPI 1053478164 - Preferred Provider Organization - 305R00000X

NPI Details
NPI 1053478164
Enumeration Date 01/02/2007
Last Updated 07/08/2007
Entity Type Healthcare Provider
Active Over 9 years ago
Authorized Information
Name EARLENE EARLENE
Position PROGRAM MANAGER
Phone (218) 335-4514
Fax (218) 335-4580
Practice Location
110 BALSAM AVE. NW
CASS LAKE MN, 56633, US
Phone (218) 335-4514
Fax (218) 335-4580
Business Location
115 6TH ST NE
SUITE E
CASS LAKE MN, 56633-3428, US
Phone (218) 335-4514
Fax (218) 335-4580
Toxanomy
Taxonomy Code 305R00000X
License State
License Number
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According to our database, Leech Lake Opiate Treatment Program NPI is 1053478164, taxonomy code is 305R00000X Leech Lake Opiate Treatment Program physically located at 110 Balsam Ave. Nw, Cass Lake MN, 56633. NPI Number 1033115704 has the healthcare provider type.

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1053478164 NPI number is provided on an as is basis without warranty of any kind. 1053478164 is maintained by the National Plan & Provider Enumeration System. The contents of Leech Lake Opiate Treatment Program are for informational purposes only.