Organization
RED LAKE CHEMICAL HEALTH PROGRAMS
Active
Other names
Red Lake Group Home
Organization subpart
No
Provider details
NPI number
Authorized official
REYNA CRUZ GONZALEZ-RIVERA (PROJECT DIRECTOR)
(218) 679-3392
Entity
Organization
Contact information
Practice address
14414 GREEN LAKE ROAD, REDBY, MN 56670
(218) 679-3868
(218) 679-3398
Mailing address
P.O. BOX 114, RED LAKE, MN 56671
Taxonomy
Speciality
Code
Description
License number
State
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary
—
—
Other
Enumeration date
01/08/2018
Last updated
01/08/2018
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