Organization
MINNESOTA INDIAN PRIMARY RESIDENTIAL TREATMENT CENTER, INC.
Active
Other names
Thunderbird-Wren House
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES W MALLERY II (ADMINISTRATOR)
(218) 879-6731
Entity
Organization
Contact information
Practice address
9302 IDAHO STREET, DULUTH, MN 55808
(218) 727-7699
(218) 727-1476
Mailing address
PO BOX 66, SAWYER, MN 55780
(218) 879-6731
(218) 879-6734
Taxonomy
Speciality
Code
Description
License number
State
177F00000X
Lodging Provider
8025091CDT
MN
177F00000X
Lodging Provider
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
786355100
—
MN
01
—
9594TH
BCBS OF MINNESOTA
MN
Enumeration date
12/04/2006
Last updated
05/08/2023
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