Organization
RED LAKE CHEMICAL HEALTH PROGRAMS
Active
Organization
RED LAKE CHEMICAL HEALTH PROGRAMS
Active
Parent organization
RED LAKE CHEMICAL HEALTH PROGRAMS
Other names
Pregnant Women & Families Outpatient
Organization subpart
Yes
Provider details
NPI number
Legal business name
RED LAKE CHEMICAL HEALTH PROGRAMS
Authorized official
REYNA CRUZ GONZALEZ-RIVERA (PROJECT DIRECTOR)
(218) 679-3392
Entity
Organization
Contact information
Practice address
15797 MAIN AVE, RED LAKE, MN 56671-0114
(218) 679-3331
(218) 679-3302
Mailing address
P.O. BOX 114, RED LAKE, MN 56671
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1003
TRIBAL LICENSE
MN
Enumeration date
01/12/2018
Last updated
03/19/2019
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