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Organization

LEECH LAKE TRIBAL COUNCIL

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JOEL D BEBEAU (HEALTH DIRECTOR)
(218) 335-4500
Entity
Organization

Contact information

Practice address
115 6TH ST NE, CASS LAKE, MN 56633-3428
(218) 335-4500
(218) 335-4547
Mailing address
115 6TH ST NE, CASS LAKE, MN 56633-3428
(218) 335-4500
(218) 335-4547

Taxonomy

Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
640717000
MN
Enumeration date
08/30/2006
Last updated
11/30/2010
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