NPIMap

Organization Active NPI

Red Lake Chemical Health Programs

  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
  • Ponemah, MN
National Provider Identifier
1992213839
Registry record updated Mar 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Indian Health Service/Tribal/Urban Indian Health (I/T/U) PharmacyTaxonomy code 332800000X
Legal business name
RED LAKE CHEMICAL HEALTH PROGRAMS
Practice address
19195 North Ponemah Road
Ponemah, MN 56666
Phone
(218) 554-7425
Fax
(218) 554-7325
NPI assigned
Jan 12, 2018
Organization subpart
Yes
Parent organization
PONEMAH OUTPATIENTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 20, 2019

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

Authorized official

Name
Reyna Cruz Gonzalez-Rivera
Title
Project Director
Phone
(218) 679-3392

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 332800000X Primary

Addresses

Primary practice location

19195 North Ponemah Road
Ponemah, MN 56666

Mailing address

P.O. Box 114
Red Lake, MN 56671

Other identifiers 1

IdentifierTypeStateIssuer
1004OtherMNTRIBAL LICENSE

Other names 1

  • Ponemah Outpatient Other name

National Provider Directory

National Provider Directory
Tax ID family
Red Lake Chemical Health Programs Outpatient28 organizations share this tax ID, including this one
Part of
Red Lake Chemical Health Programs 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": "1515715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553040000000",
    "number": "1992213839",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19195 NORTH PONEMAH ROAD",
            "city": "PONEMAH",
            "state": "MN",
            "postal_code": "56666",
            "telephone_number": "218-554-7425",
            "fax_number": "218-554-7325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RED LAKE CHEMICAL HEALTH PROGRAMS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PONEMAH OUTPATIENT",
        "enumeration_date": "2018-01-12",
        "last_updated": "2019-03-20",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ-RIVERA",
        "authorized_official_first_name": "REYNA",
        "authorized_official_middle_name": "CRUZ",
        "authorized_official_title_or_position": "PROJECT DIRECTOR",
        "authorized_official_telephone_number": "218-679-3392"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRIBAL LICENSE",
            "identifier": "1004",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ponemah Outpatient",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Ponemah, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2019; 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.