Organization
MINNESOTA INDIAN PRIMARY RESIDENTIAL TREATMENT CENTER, INC.
Active
Organization
MINNESOTA INDIAN PRIMARY RESIDENTIAL TREATMENT CENTER, INC.
Active
Other names
Mash-ka-wisen Treatment Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES W MALLERY II (BUSINESS MANAGER)
(218) 879-6731
Entity
Organization
Contact information
Practice address
1150 MISSION RD, SAWYER, MN 55780-0066
(218) 879-6731
(218) 879-6734
Mailing address
PO BOX 66, SAWYER, MN 55780-0066
(218) 879-6731
(218) 879-6734
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
111904
UCARE
MN
01
—
5013717
MEDICA
MN
01
—
8103MA
BCBS OF MINNESOTA
MN
01
—
9825MA
BCBS OF MINNESOTA
MN
Enumeration date
12/04/2006
Last updated
08/22/2020
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