| NPI | 1730696154 |
|---|---|
| Former Legal Business Name | RED LAKE GROUP HOME |
| 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 |
| Enumeration Date | 2018-01-08 |
| Last Update Date | 2018-01-08 |