Organization
LEECH LAKE OPIATE TREATMENT PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. EARLENE BUFFALO (PROGRAM MANAGER)
(218) 335-8304
Entity
Organization
Contact information
Practice address
110 BALSAM AVE. NW, CASS LAKE, MN 56633
(218) 335-4514
(218) 335-4580
Mailing address
115 6TH ST. NW, SUITE E, CASS LAKE, MN 56633
(218) 335-4514
(218) 335-4580
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
—
—
Other
Enumeration date
12/21/2006
Last updated
08/22/2020
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