Provider Demographics
NPI:1124214887
Name:RED LAKE BAND OF CHIPPEWA INDIANS
Entity Type:Organization
Organization Name:RED LAKE BAND OF CHIPPEWA INDIANS
Other - Org Name:RED LAKE FAMILY & CHILDREN SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARSONS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:218-679-2122
Mailing Address - Street 1:PO BOX 472
Mailing Address - Street 2:
Mailing Address - City:REDLAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56671-0472
Mailing Address - Country:US
Mailing Address - Phone:218-679-2122
Mailing Address - Fax:218-679-2929
Practice Address - Street 1:15816 AGENCY STREET
Practice Address - Street 2:
Practice Address - City:REDLAKE
Practice Address - State:MN
Practice Address - Zip Code:56671-0472
Practice Address - Country:US
Practice Address - Phone:218-679-2122
Practice Address - Fax:218-679-2929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-17
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health