LEECH LAKE OPIATE TREATMENT PROGRAM


Address: 110 Balsam Ave. Nw, Cass Lake, MN 56633
Phone: 2183354514

LEECH LAKE OPIATE TREATMENT PROGRAM (NPI# 1053478164) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1053478164
Entity Type Organization
Organization Name LEECH LAKE OPIATE TREATMENT PROGRAM
Practice Address 110 Balsam Ave. Nw
Cass Lake
MN 56633
Mailing Address 115 6th St Ne
Suite E
Cass Lake
MN 56633-3428
Practice Telephone 2183354514
Practice Fax Number 2183354580
Mailing Telephone 2183354514
Mailing Fax Number 2183354580
Enumeration Date 2007-01-02
Last Update Date 2020-08-22
Authorized Official Name MRS. EARLENE BUFFALO (PROGRAM MANAGER)
Authorized Official Telephone 2183358304
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 305R00000X Preferred Provider Organization Managed Care Organizations

Other Provider IDs and Locations

NPI Name Taxonomy Address Enumeration
1578627451 Leech Lake Opiate Treatment Program Preferred Provider Organization 110 Balsam Ave. Nw, Cass Lake, MN 56633 2006-12-21

Office Location

Street Address 110 BALSAM AVE. NW
City CASS LAKE
State MN
Zip Code 56633

Providers in the same location

NPI Name Taxonomy Address Enumeration
1578627451 Leech Lake Opiate Treatment Program Preferred Provider Organization 110 Balsam Ave. Nw, Cass Lake, MN 56633 2006-12-21

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1205485430 Jessica Rose Malterud Registered Nurse 416-2nd Street Nw, Cass Lake, MN 56633 2019-09-10
1174079917 Stacy Ann Cederstrom Nurse Practitioner 425 7th Street North East, Cass Lake, MN 56633 2016-08-31
1679933568 Minnesota Chippewa Tribe Adult Day Services Clinic/Center 15546 State 371 Nw, Cass Lake, MN 56633 2016-03-04
1073979084 Constance J Mangiamele Registered Nurse 190 Sailstar Dr. Nw, Cass Lake, MN 56633 2016-01-06
1194193086 Whitney Dickson Pharmacist 425 7th Street Northwest, Cass Lake, MN 56633 2015-09-09
1245669332 Marsha Ellen Kaehne Nurse Practitioner 119 Aspen Ave., Cass Lake, MN 56633 2013-11-08
1376985952 Home Free Care, LLC Home Health 310 Norway Ave. Ne, Cass Lake, MN 56633 2013-07-23
1831468479 Leech Lake Band of Ojibwe Substance Abuse Rehabilitation Facility 113 7th Stree Nw, Cass Lake, MN 56633 2011-12-28
1275823742 Leech Lake Band of Ojibwe Community/Behavioral Health 16123 Grant Utley Ave Nw, Cass Lake, MN 56633 2011-04-18
1659679843 Leech Lake Band of Ojibwe Community/Behavioral Health 115 6th Street Nw, Cass Lake, MN 56633 2011-03-11
Find all providers in zip 56633

Taxonomy Information

Taxonomy Code 305R00000X
Grouping Managed Care Organizations
Classification Preferred Provider Organization

Taxonomy Definition

A group of physicians and/or hospitals who contract with an employer to provide services to their employees. In a PPO, the patient may got to the physician of his/her choice, even if that physician does not participate in the PPO, but the patient receives care at a lower benefit level.
Notes: Source: "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/ October 1995, p. 62

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1578627451 Leech Lake Opiate Treatment Program Preferred Provider Organization 110 Balsam Ave. Nw, Cass Lake, MN 56633 2006-12-21

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1124544895 Msp Dentistry Inc Preferred Provider Organization 13650 Hanson Blvd., Suite #110, Andover, MN 55304 2017-08-15
1548708225 Valley Ridge Dental Arts Preferred Provider Organization 12425 55th St N Ste B, Lake Elmo, MN 55042-7404 2017-02-02
1063958247 Always Best Care Preferred Provider Organization 331 Maple Street, Suite 2, Saint Paul, MN 55106 2017-01-12
1417493990 Suado Hirsi Dirir Preferred Provider Organization 2605 Bloomington Ave, Minneapolis, MN 55407-1137 2017-01-09
1699226829 Hibaq Warsame Preferred Provider Organization 3655 Girard Ave N, Minneapolis, MN 55412-2020 2016-10-24
1174077572 Homecare Options Inc Preferred Provider Organization 610 Mcknight Rd S, Maplewood, MN 55119-5672 2016-08-15
1912355132 Lifestyle Living Home Care LLC Preferred Provider Organization 1 W Lake St Apt 404, Minneapolis, MN 55408-3153 2016-05-27
1306207113 Paul Perpich, Dds Preferred Provider Organization 5461 City Hall St, Nisswa, MN 56468-2478 2016-03-08
1619334281 Perfection Care Associates LLC Preferred Provider Organization 1810 Columbus Ave, Minneapolis, MN 55404-1961 2016-01-27
1699132068 Best Home Health Care Service LLC Preferred Provider Organization 6040 Clinton Ave, Minneapolis, MN 55419-2539 2016-01-15
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Competitor

Search similar providers

City CASS LAKE
Zip Code 56633

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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