NPIMap

Organization Active NPI

Leech Lake Opiate Treatment Program

  • Preferred Provider Organization
  • Cass Lake, MN
National Provider Identifier
1578627451
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preferred Provider OrganizationTaxonomy code 305R00000X
Legal business name
LEECH LAKE OPIATE TREATMENT PROGRAM
Practice address
110 Balsam Ave. NW
Cass Lake, MN 56633
Phone
(218) 335-4514
Fax
(218) 335-4580
NPI assigned
Dec 21, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Earlene Buffalo
Title
Program Manager
Phone
(218) 335-8304

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Preferred Provider Organization 305R00000X NU Primary

Addresses

Primary practice location

110 Balsam Ave. NW
Cass Lake, MN 56633

Mailing address

115 6TH St. NW
Suite E
Cass Lake, MN 56633
Phone (218) 335-4514

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

NPI Registry JSON

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

{
    "created_epoch": "1166659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1578627451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 6TH ST. NW",
            "address_2": "SUITE E",
            "city": "CASS LAKE",
            "state": "MN",
            "postal_code": "56633",
            "telephone_number": "218-335-4514",
            "fax_number": "218-335-4580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 BALSAM AVE. NW",
            "city": "CASS LAKE",
            "state": "MN",
            "postal_code": "56633",
            "telephone_number": "218-335-4514",
            "fax_number": "218-335-4580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEECH LAKE OPIATE TREATMENT PROGRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BUFFALO",
        "authorized_official_first_name": "EARLENE",
        "authorized_official_title_or_position": "PROGRAM MANAGER",
        "authorized_official_telephone_number": "218-335-8304",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Aug 22, 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.