Organization
RED LAKE BAND OF CHIPPEWA INDIANS
Active
Other names
Red Lake Urban Avivo Services
Organization subpart
No
Provider details
NPI number
Authorized official
ALISHA MARIE GEHLERT (ECONOMIC DEV. DIRECTOR)
(218) 679-1461
Entity
Organization
Contact information
Practice address
1900 CHICAGO AVE, MINNEAPOLIS, MN 55404-1903
(218) 679-1455
(651) 383-4937
Mailing address
PO BOX 587, REDLAKE, MN 56671-0587
(218) 679-1455
(651) 383-4937
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary
—
—
Other
Enumeration date
09/24/2019
Last updated
09/24/2019
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