| Organization Name: | LEECH LAKE OPIATE TREATMENT CENTER |
| NPI Number: | 1649401357 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | REBECCA WHITE (PROGRAM MANAGER) |
| Mailing Address: | 108 Balsam Leech Opiate Treatment Center Cass Lake |
| State: | MN US |
| Postal Code: | 566333428 |
| Phone Number: | 2183358304 |
| Fax Number: | 2183354580 |
| NPI Enumeration Date: | 07/29/2009 |
| NPI Last Update Date: | 07/29/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 302R00000X |
| License Number: | 05125 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Managed Care Organizations |
| Taxonomy Classification: | Health Maintenance Organization |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) A form of health insurance in which its members prepay a premium for the HMO |