NPIMap

Organization Active NPI

Mille Lacs Band of Ojibwe Indians

Doing business as Four Winds Lodge

  • Substance Abuse Rehabilitation Facility
  • Brainerd, MN
National Provider Identifier
1285186007
Registry record updated Oct 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
MILLE LACS BAND OF OJIBWE INDIANS
Doing business as
Four Winds Lodge
Practice address
11600 State Ave
Brainerd, MN 56401
Phone
(320) 532-4163
NPI assigned
Oct 27, 2016
Last updated
Oct 14, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
MILLE LACS BAND OF OJIBWE INDIANSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 14, 2021

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

Authorized official

Name
Nicole Anderson
Title
HHS Commissioner
Phone
(320) 532-4163

Specialties & licenses 1

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

Addresses

Primary practice location

11600 State Ave
Brainerd, MN 56401

Mailing address

18562 Minobimaadizi Loop
Onamia, MN 56359-3001
Phone (320) 532-4163

Other names 1

  • Four Winds Lodge Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Mille Lacs Band of Ojibwe Indians16 organizations share this tax ID, including this one
Part of
Mille Lacs Band of Ojibwe Indians

Other organizations with this tax ID 15

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

View all 15

Locations

11600 State Ave
Brainerd, MN 56401
Phone (218) 330-7455

43500 Migizi Dr
Ofc Bom
Onamia, MN 56359

Practitioners & affiliated clinicians

Practitioners 2

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": "1477526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634169600000",
    "number": "1285186007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18562 MINOBIMAADIZI LOOP",
            "city": "ONAMIA",
            "state": "MN",
            "postal_code": "563593001",
            "telephone_number": "320-532-4163",
            "fax_number": "320-532-7495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11600 STATE AVE",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "56401",
            "telephone_number": "320-532-4163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILLE LACS BAND OF OJIBWE INDIANS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MILLE LACS BAND OF OJIBWE INDIANS",
        "enumeration_date": "2016-10-27",
        "last_updated": "2021-10-14",
        "certification_date": "2021-10-14",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "HHS COMMISSIONER",
        "authorized_official_telephone_number": "320-532-4163"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Four Winds Lodge",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brainerd, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2021; 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.