MEDICARE: RED LAKE COMPREHENSIVE HEALTH SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	101YP2500X	Professional Counselor	MN
2	124Q00000X	Dental Hygienist
3	1041C0700X	Clinical Social Worker
4	146N00000X	Basic Emergency Medical Technician	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841337326
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RED LAKE COMPREHENSIVE HEALTH SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 249
Second Line	:
City	:	REDLAKE
State	:	MN
Zip	:	56671-0249
Country	:	US
Telephone Number	:	218-679-3316
Fax Number	:	218-679-3990

Provider Business Practice Location Address
First Line	:	24760 HOSPITAL DRIVE
Second Line	:
City	:	REDLAKE
State	:	MN
Zip	:	56671-0249
Country	:	US
Telephone Number	:	218-679-3316
Fax Number	:	218-679-3990

Authorized Official
Title or Position	:	TRIBAL HEALTH DIRECTOR
Name	:	ORAN D. BEAULIEU
Credential	:
Telephone Number	:	218-679-3316

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	05/20/2008

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Directions to “RED LAKE COMPREHENSIVE HEALTH SERVICES ” Practice Location

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