LEECH LAKE BAND OF OJIBWE (NPI# 1275823742) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275823742 |
| Entity Type | Organization |
| Organization Name | LEECH LAKE BAND OF OJIBWE |
| Other Organization Name | LEECH LAKE BEHAVIORAL HEALTH |
| Practice Address |
16123 Grant Utley Ave Nw Cass Lake MN 56633 |
| Mailing Address |
115 6th Street Nw, Ste. E Cass Lake MN 56633 |
| Practice Telephone | 2183353050 |
| Practice Fax Number | 2183354410 |
| Mailing Telephone | 2183353050 |
| Mailing Fax Number | 2183354410 |
| Enumeration Date | 2011-04-18 |
| Last Update Date | 2020-02-28 |
| Authorized Official Name | EARL ROBINSON (LEECH LAKE HUMAN SERVICES DIRECTOR) |
| Authorized Official Telephone | 2183358295 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 251S00000X | Community/Behavioral Health | 19439 | MN | Agencies |
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
MN | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Leech Lake Behavioral Health | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831468479 | Leech Lake Band of Ojibwe | Substance Abuse Rehabilitation Facility | 113 7th Stree Nw, Cass Lake, MN 56633 | 2011-12-28 |
| 1295029817 | Leech Lake Band of Ojibwe | Community/Behavioral Health | 15353 Silver Eagle Dr Nw, Bena, MN 56626-3675 | 2011-05-31 |
| 1659679843 | Leech Lake Band of Ojibwe | Community/Behavioral Health | 115 6th Street Nw, Cass Lake, MN 56633 | 2011-03-11 |
| 1801065495 | Leech Lake Band of Ojibwe | Substance Abuse Rehabilitation Facility | 16599 69th Avenue Nw, Cass Lake, MN 56633 | 2008-02-27 |
| 1194909085 | Leech Lake Band of Ojibwe | Case Management | 120 2nd St Nw, Cass Lake, MN 56633 | 2007-12-27 |
| 1679781116 | Leech Lake Band of Ojibwe | Substance Abuse Rehabilitation Facility | 115 Sixth Street Northwest, Suite E, Cass Lake, MN 56633 | 2007-05-18 |
| 1215341094 | Leech Lake Band of Ojibwe | Clinic/Center | 321 2nd St, Cass Lake, MN 56633 | 2014-06-19 |
| 1962610824 | Leech Lake Band of Ojibwe | Substance Abuse Rehabilitation Facility | 115 Sixth Street Northwest, 6905 161st Street, Cass Lake, MN 56633 | 2007-05-21 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | LEECH LAKE BAND OF OJIBWE NATURAL WILD RICE | 190 Sailstar Dr Nw, Cass Lake, MN 56633-3565 |
| Street Address |
16123 GRANT UTLEY AVE NW |
| City | CASS LAKE |
| State | MN |
| Zip Code | 56633 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245838606 | Carol Borden | Counselor | 16123 Grant Utley Ave Nw, Cass Lake, MN 56601 | 2020-10-16 |
| 1346644986 | Kathleen Wright | Social Worker | 16123 Grant Utley Ave Nw, Cass Lake, MN 56633 | 2014-10-10 |
| 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 |
| 1659679843 | Leech Lake Band of Ojibwe | Community/Behavioral Health | 115 6th Street Nw, Cass Lake, MN 56633 | 2011-03-11 |
| 1831491315 | Rita Marie Schuldt | Dietitian, Registered | 115 6th St. Nw Ste. 6, Cass Lake, MN 56633 | 2010-12-03 |
| Find all providers in zip 56633 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427479187 | Leech Lake Tribal Council | Clinic/Center | 115 6th St Nw Ste E, Cass Lake, MN 56633-3428 | 2013-12-26 |
| 1942310875 | Leech Lake Tribal Council | Clinic/Center | 115 6th St Ne, Cass Lake, MN 56633-3428 | 2006-08-30 |
| 1215341094 | Leech Lake Band of Ojibwe | Clinic/Center | 321 2nd St, Cass Lake, MN 56633 | 2014-06-19 |
| 1639368863 | Leech Lake Reservation | Clinic/Center | 115 6th St Ne, Suite E, Cass Lake, MN 56633-3428 | 2007-10-24 |
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| 1891266862 | Hennepin County | Clinic/Center | 41 N 12th St., Minneapolis, MN 55403-1325 | 2018-12-17 |
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| Find all providers with the same taxonomy | ||||
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| 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.