Ponemah Outpatient

LBN: Red Lake Chemical Health Programs
Ponemah Outpatient is an health care organization with primary practice located at 19195 North Ponemah Road , Ponemah MN 56666. The organization recently has 2 registered licenses in different health care specialties including Residential Treatment Facilities / Substance Abuse Rehabilitation Facility, Suppliers / Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy. Suppliers / Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy is the primary health care specialty. Red Lake Chemical Health Programs can be contacted via phone (218) 554-7425, or through Gonzalez-Rivera, Reyna Cruz via phone (218) 679-3392.

Contact Information

Primary practice address
19195 North Ponemah Road Ponemah MN 56666
Phone: (218) 554-7425
Fax: (218) 554-7325
Website:
Map and Directions
Authorized official contact:
Name: Gonzalez-Rivera, Reyna Cruz
Phone: (218) 679-3392

Health care specialties

SpecialtyCodeLicense #State
Residential Treatment Facilities / Substance Abuse Rehabilitation Facility 324500000X
Suppliers / Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 332800000X

Profile Details

NPI number 1992213839
LBN Legal business name Red Lake Chemical Health Programs
DBA Doing business as Ponemah Outpatient
Authorized official Gonzalez-Rivera, Reyna Cruz
Entity Organization
Organization subpart 1 Yes
Enumeration date Jan 12th, 2018
Last updated Mar 20th, 2019 - about 5 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1992213839 NPPES
Minnesota Other 1004 TRIBAL LICENSE

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