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Organization
LEECH LAKE BAND OF OJIBWE
Active
Organization
LEECH LAKE BAND OF OJIBWE
Active
Other names
Leech Lake Adolescent Outpatient Services
Organization subpart
No
Provider details
NPI number
Authorized official
EARL ROBINSON (HUMAN SERVICES DIRECTOR)
(218) 335-8295
Entity
Organization
Contact information
Practice address
321 2ND ST, CASS LAKE, MN 56633
(218) 335-8382
(218) 335-3580
Mailing address
190 SAILSTAR DR NW, CASS LAKE, MN 56633
(218) 335-8382
(218) 335-3580
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
06/19/2014
Last updated
01/31/2019
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