Organization
LEECH LAKE BAND OF OJIBWE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GEORGE GOGGLEYE (CHAIRMAN)
(218) 335-8200
Entity
Organization
Contact information
Practice address
115 SIXTH STREET NORTHWEST, SUITE E, CASS LAKE, MN 56633
(218) 335-8308
(218) 335-8307
Mailing address
115 SIXTH STREET NORTHWEST, SUITE E, CASS LAKE, MN 56633
(218) 335-8308
(218) 335-8307
Taxonomy
Speciality
Code
Description
License number
State
3245S0500X
Children's Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
05/18/2007
Last updated
08/22/2020
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