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Organization
RED LAKE CHEMICAL HEALTH PROGRAMS OUTPATIENT
Active
Organization
RED LAKE CHEMICAL HEALTH PROGRAMS OUTPATIENT
Active
Other names
RED LAKE OUTPATIENT PROGRAM
Organization subpart
No
Provider details
NPI number
Authorized official
SALENA L BRANCHAUD (PROGRAM MANGER)
(218) 679-3392
Entity
Organization
Contact information
Practice address
15797 MAIN AVE, HWY 1, REDLAKE, MN 56671-0114
(218) 679-3392
(218) 679-3976
Mailing address
PO BOX 114, REDLAKE, MN 56671-0114
(218) 679-3392
(218) 679-3976
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
627635100
—
MN
Enumeration date
05/18/2007
Last updated
03/27/2019
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