Organization
RED LAKE MEDICATION ASSISTED RECOVERY SERVICES
Active
Parent organization
RED LAKE MEDICATION ASSISTED RECOVERY SERVICES
Organization subpart
Yes
Provider details
NPI number
Legal business name
RED LAKE MEDICATION ASSISTED RECOVERY SERVICES
Authorized official
MRS. SALENA LEIGH BEASLEY (EXECUTIVE DIRECTOR)
(218) 679-1543
Entity
Organization
Contact information
Practice address
24760 HOSPITAL DRIVE, RED LAKE, MN 56671
(218) 679-3995
(218) 679-3976
Mailing address
P.O. BOX 114, RED LAKE, MN 56671
(218) 679-3996
(217) 679-3976
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1002
TRIBAL LICENSE
MN
Enumeration date
09/15/2017
Last updated
09/15/2017
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