LEECH LAKE BEHAVIORAL HEALTH – NPI #1275823742
Clinic/Center

LEECH LAKE BEHAVIORAL HEALTH is an AHC clinic located in CASS LAKE, MN. NPPES has assigned the NPI number 1275823742 to LEECH LAKE BEHAVIORAL HEALTH on April 18, 2011. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “LEECH LAKE BEHAVIORAL HEALTH” is a dba name, the actual legal business name for this organization is LEECH LAKE BAND OF OJIBWE. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 261QF0400X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Federally Qualified Health Center (FQHC)

The NPI profile was previously updated about 6 years ago on Feb 28, 2020. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for LEECH LAKE BEHAVIORAL HEALTH below.

NPI Profile for
LEECH LAKE BAND OF OJIBWE

NPI Number
1275823742
Enumeration Date

(more than 15 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
LEECH LAKE BAND OF OJIBWE
Doing Business As (dba): LEECH LAKE BEHAVIORAL HEALTH
Primary location
16123 GRANT UTLEY AVE NW
CASS LAKE, MN 56633
Phone: (218) 335-3050 Fax: (218) 335-4410
Mailing address
115 6TH STREET NW, STE. E
CASS LAKE, MN 56633
Phone: (218) 335-3050 Fax: (218) 335-4410
Organization Subpart
No
Authorized Official
EARL ROBINSON
LEECH LAKE HUMAN SERVICES DIRECTOR
Phone: (218) 335-8295
Updated
Certification Date
Feb 28, 2020

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QF0400X
- Clinic/Center / Federally Qualified Health Center (FQHC) (Primary)		 MN
251S00000X
- Community/Behavioral Health		 MN 19439

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.