Provider Demographics
NPI:1376753160
Name:RED LAKE DEPARTMENT OF FAMILY AND CHILDREN SERVICES
Entity Type:Organization
Organization Name:RED LAKE DEPARTMENT OF FAMILY AND CHILDREN SERVICES
Other - Org Name:
Other - Org Type:
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 427
Mailing Address - Street 2:
Mailing Address - City:REDLAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56671-0427
Mailing Address - Country:US
Mailing Address - Phone:218-679-2122
Mailing Address - Fax:218-679-2929
Practice Address - Street 1:13586 TRIBAL AGENCY STREET
Practice Address - Street 2:
Practice Address - City:REDLAKE
Practice Address - State:MN
Practice Address - Zip Code:56671-0427
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:2007-05-23
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0001324322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children