NPIMap

Organization Active NPI

Leech Lake Band of Ojibwe

Doing business as Leech Lake Behavioral Health

  • Federally Qualified Health Center (FQHC)
  • Cass Lake, MN
National Provider Identifier
1275823742
Registry record updated Feb 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
LEECH LAKE BAND OF OJIBWE
Doing business as
Leech Lake Behavioral Health
Practice address
16123 Grant Utley Ave NW
Cass Lake, MN 56633
Phone
(218) 335-3050
Fax
(218) 335-4410
NPI assigned
Apr 18, 2011
Last updated
Feb 28, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2020

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

Authorized official

Name
Earl Robinson
Title
Leech Lake Human Services Director
Phone
(218) 335-8295

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X MN Primary
Community/Behavioral Health Agency 251S00000X 19439 MN

Addresses

Primary practice location

16123 Grant Utley Ave NW
Cass Lake, MN 56633

Mailing address

115 6TH Street NW, Ste. E
Cass Lake, MN 56633
Phone (218) 335-3050

Other names 1

  • Leech Lake Behavioral Health Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Leech Lake Outpatient Treatment Program19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

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

View all 18

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1303084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582848000000",
    "number": "1275823742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 6TH STREET NW, STE. E",
            "city": "CASS LAKE",
            "state": "MN",
            "postal_code": "56633",
            "telephone_number": "218-335-3050",
            "fax_number": "218-335-4410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16123 GRANT UTLEY AVE NW",
            "city": "CASS LAKE",
            "state": "MN",
            "postal_code": "56633",
            "telephone_number": "218-335-3050",
            "fax_number": "218-335-4410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEECH LAKE BAND OF OJIBWE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-18",
        "last_updated": "2020-02-28",
        "certification_date": "2020-02-28",
        "status": "A",
        "authorized_official_last_name": "ROBINSON",
        "authorized_official_first_name": "EARL",
        "authorized_official_title_or_position": "LEECH LAKE HUMAN SERVICES DIRECTOR",
        "authorized_official_telephone_number": "218-335-8295"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "MN",
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MN",
            "license": "19439",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Leech Lake Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Leech Lake Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cass Lake, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2020; 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.