Provider Demographics
NPI:1326212721
Name:RED LAKE CHEMICAL HEALTH TREATMENT CENTER
Entity Type:Organization
Organization Name:RED LAKE CHEMICAL HEALTH TREATMENT CENTER
Other - Org Name:NORTHERN WINDS TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SALENA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANCHAUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-679-3995
Mailing Address - Street 1:PO BOX 114
Mailing Address - Street 2:
Mailing Address - City:REDLAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56671-0114
Mailing Address - Country:US
Mailing Address - Phone:218-679-3995
Mailing Address - Fax:218-679-3976
Practice Address - Street 1:15797 MAIN AVENUE
Practice Address - Street 2:
Practice Address - City:REDLAKE
Practice Address - State:MN
Practice Address - Zip Code:56671
Practice Address - Country:US
Practice Address - Phone:218-679-3995
Practice Address - Fax:218-679-3976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility