NPIMap

Organization Active NPI

Warrior Down - Peer Recovery Support

  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
  • Red Lake, MN
National Provider Identifier
1003332057
Registry record updated Nov 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Indian Health Service/Tribal/Urban Indian Health (I/T/U) PharmacyTaxonomy code 332800000X
Legal business name
WARRIOR DOWN - PEER RECOVERY SUPPORT
Practice address
15533 Main Avenue
Red Lake, MN 56671-0114
Phone
(218) 679-3392
NPI assigned
Aug 21, 2017
Last updated
Nov 27, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Salena Beasley
Title
Admin Officer
Phone
(218) 679-3392

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X NU
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 332800000X NU Primary

Addresses

Primary practice location

15533 Main Avenue
Red Lake, MN 56671-0114

Mailing address

P.O. Box 114
Red Lake, MN 56671
Phone (218) 679-3995

Other practice location 1

25064 Highway 1 East
Red Lake, MN 56671
Phone (218) 679-3995 ext. 1543

Other identifiers 1

IdentifierTypeStateIssuer
1001OtherMNTRIBAL LICENSE

Other names 1

  • Red Lake Detention Outpatient Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Nacc Tribal Health Services28 organizations share this tax ID, including this one

Other organizations with this tax ID 27

Organizations that report the same tax identification number in the National Provider Directory.

View all 27

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1503273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732665600000",
    "number": "1003332057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 114",
            "city": "RED LAKE",
            "state": "MN",
            "postal_code": "56671",
            "telephone_number": "218-679-3995",
            "fax_number": "218-679-3976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15533 MAIN AVENUE",
            "city": "RED LAKE",
            "state": "MN",
            "postal_code": "566710114",
            "telephone_number": "218-679-3392"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "25064 Highway 1 East",
            "address_purpose": "LOCATION",
            "city": "Red Lake",
            "state": "MN",
            "postal_code": "56671",
            "country_code": "US",
            "telephone_number": "218-679-3995 x1543",
            "fax_number": "218-679-3976",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WARRIOR DOWN - PEER RECOVERY SUPPORT",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-21",
        "last_updated": "2024-11-27",
        "certification_date": "2024-11-26",
        "status": "A",
        "authorized_official_last_name": "BEASLEY",
        "authorized_official_first_name": "SALENA",
        "authorized_official_title_or_position": "ADMIN OFFICER",
        "authorized_official_telephone_number": "218-679-3392",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRIBAL LICENSE",
            "identifier": "1001",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Red Lake Detention Outpatient",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Red Lake Detention Outpatient",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Red Lake, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.