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Organization
WARRIOR DOWN - PEER RECOVERY SUPPORT
Active
Organization
WARRIOR DOWN - PEER RECOVERY SUPPORT
Active
Other names
Red Lake Detention Outpatient
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SALENA BEASLEY (ADMIN OFFICER)
(218) 679-3392
Entity
Organization
Contact information
Practice address
15533 MAIN AVENUE, RED LAKE, MN 56671-0114
(218) 679-3392
Mailing address
P.O. BOX 114, RED LAKE, MN 56671
(218) 679-3995
(218) 679-3976
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
—
—
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1001
TRIBAL LICENSE
MN
Enumeration date
08/21/2017
Last updated
11/27/2024
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