| Organization Name: | LEECH LAKE TRIBAL COUNCIL |
| NPI Number: | 1427479187 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CARRI JONES (TRIBAL CHAIRMAN) |
| Mailing Address: | 115 6th St Nw Ste E Cass Lake |
| State: | MN US |
| Postal Code: | 566333428 |
| Phone Number: | 2183354446 |
| Fax Number: | 2183353685 |
| NPI Enumeration Date: | 12/26/2013 |
| NPI Last Update Date: | 12/26/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QF0400X |
| License Number: | 302091 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
| Taxonomy Definition: | |