| NPI | 1003332057 |
|---|---|
| Former Legal Business Name | RED LAKE DETENTION OUTPATIENT |
| Entity Type | Organization |
| Authorized Contact | REYNA CRUZ GONZALEZ-RIVERA Project Director 218-679-3392 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332800000X Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2017-08-21 |
| Last Update Date | 2019-03-20 |