NPIMap

Organization Active NPI

Leech Lake Band of Ojibwe

  • Substance Abuse Rehabilitation Facility
  • Cass Lake, MN
National Provider Identifier
1962610824
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
LEECH LAKE BAND OF OJIBWE
Practice address
115 Sixth Street Northwest
6905 161St Street
Cass Lake, MN 56633
Phone
(218) 335-8303
Fax
(218) 335-8307
NPI assigned
May 21, 2007
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
Mr. George Goggleye
Title
Chairman
Phone
(218) 335-8200

Specialties & licenses 1

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

Addresses

Primary practice location

115 Sixth Street Northwest
6905 161St Street
Cass Lake, MN 56633

Mailing address

115 Sixth Street Northwest
Cass Lake, MN 56633
Phone (218) 335-8303

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

Locations

115 6th St NW
Cass Lake, MN 56633

NPI Registry JSON

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

{
    "created_epoch": "1179705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1962610824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 SIXTH STREET NORTHWEST",
            "city": "CASS LAKE",
            "state": "MN",
            "postal_code": "56633",
            "telephone_number": "218-335-8303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 SIXTH STREET NORTHWEST",
            "address_2": "6905 161ST STREET",
            "city": "CASS LAKE",
            "state": "MN",
            "postal_code": "56633",
            "telephone_number": "218-335-8303",
            "fax_number": "218-335-8307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEECH LAKE BAND OF OJIBWE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GOGGLEYE",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_title_or_position": "CHAIRMAN",
        "authorized_official_telephone_number": "218-335-8200",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "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.