Healthcare Provider Details

I. General information

NPI: 1295486447
Provider Name (Legal Business Name): OBAASHING WOMEN'S TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2022
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27190 NORTH SHORE RD
PONEMAH MN
56666-0069
US

IV. Provider business mailing address

PO BOX 566
REDLAKE MN
56671-0566
US

V. Phone/Fax

Practice location:
  • Phone: 218-679-1160
  • Fax:
Mailing address:
  • Phone: 218-679-1320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHARLENE ANDERSEN
Title or Position: REVENUE GENERATION DIRECTOR
Credential:
Phone: 218-679-1320