Organization
RED LAKE CHEMICAL HEALTH PROGRAMS OUTPATIENT
Active
Other names
RED LAKE OUTPATIENT PROGRAM
Organization subpart
No
Provider details
NPI number
Authorized official
SALENA L BRANCHAUD (PROGRAM MANGER)
(218) 679-3392
Entity
Organization
Contact information
Practice address
15797 MAIN AVE, HWY 1, REDLAKE, MN 56671-0114
(218) 679-3392
(218) 679-3976
Mailing address
PO BOX 114, REDLAKE, MN 56671-0114
(218) 679-3392
(218) 679-3976
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
627635100
—
MN
Enumeration date
05/18/2007
Last updated
03/27/2019
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