Provider Demographics
NPI:1689225351
Name:RED LAKE BAND OF CHIPPEWA INDIANS
Entity Type:Organization
Organization Name:RED LAKE BAND OF CHIPPEWA INDIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ECONOMIC DEV. DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALISHA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GEHLERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-679-1461
Mailing Address - Street 1:PO BOX 587
Mailing Address - Street 2:
Mailing Address - City:REDLAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56671-0587
Mailing Address - Country:US
Mailing Address - Phone:218-679-1455
Mailing Address - Fax:651-383-4937
Practice Address - Street 1:1900 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-1903
Practice Address - Country:US
Practice Address - Phone:218-679-1455
Practice Address - Fax:651-383-4937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
No251B00000XAgenciesCase Management