NPIMap

Organization Active NPI

Obaashing Treatment Center

  • Substance Abuse Rehabilitation Facility
  • Ponemah, MN
National Provider Identifier
1104412402
Registry record updated Mar 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
OBAASHING TREATMENT CENTER
Practice address
27190 North Shore Rd
Ponemah, MN 56666
Phone
(218) 679-3341
NPI assigned
Dec 21, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2022

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

Authorized official

Name
Charlene Andersen
Title
Revenue Generation Director
Phone
(218) 679-1320

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X Primary

Addresses

Primary practice location

27190 North Shore Rd
Ponemah, MN 56666

Mailing address

PO Box 566
Redlake, MN 56671-0566
Phone (218) 679-1160

Other names 1

  • Obaashing Treatment Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Red Lake Chemical Health Programs Outpatient28 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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1608508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647216000000",
    "number": "1104412402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 566",
            "city": "REDLAKE",
            "state": "MN",
            "postal_code": "566710566",
            "telephone_number": "218-679-1160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27190 NORTH SHORE RD",
            "city": "PONEMAH",
            "state": "MN",
            "postal_code": "56666",
            "telephone_number": "218-679-3341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OBAASHING TREATMENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-21",
        "last_updated": "2022-03-14",
        "certification_date": "2021-08-20",
        "status": "A",
        "authorized_official_last_name": "ANDERSEN",
        "authorized_official_first_name": "CHARLENE",
        "authorized_official_title_or_position": "REVENUE GENERATION DIRECTOR",
        "authorized_official_telephone_number": "218-679-1320"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Obaashing Treatment Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ponemah, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2022; 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.