NPI 1053478164

Leech Lake Opiate Treatment Program

Organisation Preferred Provider Organization Cass Lake, MN

Practice location

Address: 110 Balsam Ave. NW, Cass Lake, MN 56633
Phone: (218) 335-4514
Fax: (218) 335-4580
Mailing address: 115 6th St NE Suite E, Cass Lake, MN 56633-3428

Authorised official

Name: Earlene Buffalo
Title: Program Manager
Phone: (218) 335-8304

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X

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Registry record

NPI: 1053478164
Entity type: Organization
NPI issued: 2 Jan 2007
Record last updated: 22 Aug 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.