NPIMap

Organization Active NPI

Red Lake Medication Assisted Recovery Services

  • Community/Behavioral Health Agency
  • Red Lake, MN
National Provider Identifier
1902325426
Registry record updated Sep 15, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
RED LAKE MEDICATION ASSISTED RECOVERY SERVICES
Practice address
24760 Hospital Drive
Red Lake, MN 56671
Phone
(218) 679-3995
Fax
(218) 679-3976
NPI assigned
Sep 15, 2017
Last updated
Sep 15, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
RED LAKE MEDICATION ASSISTED RECOVERY SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 15, 2017

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

Authorized official

Name
Mrs. Salena Leigh Beasley
Title
Executive Director
Phone
(218) 679-1543

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

24760 Hospital Drive
Red Lake, MN 56671

Mailing address

P.O. Box 114
Red Lake, MN 56671
Phone (218) 679-3996

Other identifiers 1

IdentifierTypeStateIssuer
1002OtherMNTRIBAL LICENSE

National Provider Directory

National Provider Directory
Tax ID family
Red Lake Kai Shin Sud Outpatient28 organizations share this tax ID, including this one
Part of
Red Lake Kai Shin Sud Outpatient

Other organizations with this tax ID 27

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

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1505433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1505433600000",
    "number": "1902325426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 114",
            "city": "RED LAKE",
            "state": "MN",
            "postal_code": "56671",
            "telephone_number": "218-679-3996",
            "fax_number": "217-679-3976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24760 HOSPITAL DRIVE",
            "city": "RED LAKE",
            "state": "MN",
            "postal_code": "56671",
            "telephone_number": "218-679-3995",
            "fax_number": "218-679-3976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RED LAKE MEDICATION ASSISTED RECOVERY SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RED LAKE MEDICATION ASSISTED RECOVERY SERVICES",
        "enumeration_date": "2017-09-15",
        "last_updated": "2017-09-15",
        "status": "A",
        "authorized_official_last_name": "BEASLEY",
        "authorized_official_first_name": "SALENA",
        "authorized_official_middle_name": "LEIGH",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "218-679-1543",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRIBAL LICENSE",
            "identifier": "1002",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Red Lake, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2017; 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.