NPIMap

Organization Active NPI

Leech Lake Opiate Treatment Center

  • Health Maintenance Organization
  • Cass Lake, MN
National Provider Identifier
1649401357
Registry record updated Jul 29, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Maintenance OrganizationTaxonomy code 302R00000X
License
05125 Issued in MN
Legal business name
LEECH LAKE OPIATE TREATMENT CENTER
Practice address
108 Balsam
Leech Opiate Treatment Center
Cass Lake, MN 56633-3428
Phone
(218) 335-8304
Fax
(218) 335-4580
NPI assigned
Jul 29, 2009
Last updated
Jul 29, 2009By the provider in NPPES
Organization subpart
Yes
Parent organization
LEECH LAKE BAND OF OJIBWEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 29, 2009

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

Authorized official

Name
Mrs. Rebecca White, LPN
Title
Program Manager
Phone
(218) 335-8304

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Maintenance Organization 302R00000X 05125 MN Primary

Addresses

Primary practice location

108 Balsam
Leech Opiate Treatment Center
Cass Lake, MN 56633-3428

Mailing address

115 6TH St. NW
Leech Lake Band of Ojibwe #E
Cass Lake, MN 56633-3428
Phone (218) 335-8200

National Provider Directory

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

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": "1248825600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1248825600000",
    "number": "1649401357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 6TH ST. NW",
            "address_2": "LEECH LAKE BAND OF OJIBWE #E",
            "city": "CASS LAKE",
            "state": "MN",
            "postal_code": "566333428",
            "telephone_number": "218-335-8200",
            "fax_number": "218-335-4580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 BALSAM",
            "address_2": "LEECH OPIATE TREATMENT CENTER",
            "city": "CASS LAKE",
            "state": "MN",
            "postal_code": "566333428",
            "telephone_number": "218-335-8304",
            "fax_number": "218-335-4580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEECH LAKE OPIATE TREATMENT CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LEECH LAKE BAND OF OJIBWE",
        "enumeration_date": "2009-07-29",
        "last_updated": "2009-07-29",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "PROGRAM MANAGER",
        "authorized_official_telephone_number": "218-335-8304",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LPN"
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "MN",
            "license": "05125",
            "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 Jul 29, 2009; 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.