FOUR WINDS LODGE
NPI 1285186007
Substance Abuse Rehabilitation Facility in Brainerd, MN

NPI Status: Active since October 27, 2016

Contact Information

11600 STATE AVE
BRAINERD, MN
ZIP 56401
Phone: (320) 532-4163

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  • Organization
  • Substance Abuse Rehabilitation Facility
  • CLIA Number: 24D2189199
  • CLIA Cert. Type: Skilled Nursing Facility/Nursing Facility
  • CLIA Exp. Date: 07-27-2026

About FOUR WINDS LODGE

This page provides the complete NPI Profile along with additional information for Four Winds Lodge, a provider established in Brainerd, Minnesota operating as a Substance Abuse Rehabilitation Facility. The healthcare provider is registered in the NPI registry with number 1285186007 assigned on October 2016. The practitioner's primary taxonomy code is 324500000X. The provider is registered as an organization and their NPI record was last updated 4 years ago. The provider's is doing business as Four Winds Lodge. The authorized official of this NPI record is Nicole Anderson (Hhs Commissioner)

NPI
1285186007
Provider Legal Name
MILLE LACS BAND OF OJIBWE INDIANS
Other Organization Name
FOUR WINDS LODGE
Other Name Type
Doing Business As (3)
Entity Type
Organization
Location Address
11600 STATE AVE BRAINERD, MN 56401
Location Phone
(320) 532-4163
Mailing Address
18562 MINOBIMAADIZI LOOP ONAMIA, MN 56359
Mailing Phone
(320) 532-4163
Mailing Fax
Is Sole Proprietor?
No
Is Organization Subpart?
Yes
Enumeration Date
10-27-2016
Last Update Date
10-14-2021
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Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Substance Abuse Rehabilitation Facility

Taxonomy Code
324500000X
Type
Residential Treatment Facilities
Taxonomy Description
A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

NICOLE ANDERSON

Authorized Official Title
HHS COMMISSIONER
Authorized Official Phone
(320) 532-4163

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:

CLIA Number
24D2189199
Facility Type
Skilled Nursing Facility/Nursing Facility
Certificate Effective Date
July 28, 2024
Certificate Expiration Date
July 27, 2026
Laboratory Director
CHRISTINA A. STRAW
Certificate Type
Certificate of Waiver
Certificate Type Description
This CLIA certificate is issued to Four Winds Lodge to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

Reviews for FOUR WINDS LODGE

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NPI Validation Check Digit Calculation


The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1285186007
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
22165281200
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 2 + 1 + 6 + 5 + 2 + 8 + 1 + 2 + 0 + 0 + 24 = 53
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
60 - 53 = 77

The NPI number 1285186007 is valid because the calculated check digit 7 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


The following 2 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1356400444DR. TED MATZEN M.D.
Individual
Psychiatry & Neurology (Psychiatry)11600 STATE AVE
BRAINERD, MN 56401
(218) 330-7455
1013753185 KATHLEEN DIANE KONGSJORD LPCC
Individual
Counselor (Mental Health)11600 STATE AVE
BRAINERD, MN 56401
(218) 454-8919

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1285186007, enumerated in the NPI registry as an "organization" on October 27, 2016

The provider is located at 11600 State Ave Brainerd, Mn 56401 and the phone number is (320) 532-4163

This medical organization specializes in Substance Abuse Rehabilitation Facility with taxonomy code 324500000X

The provider's CLIA number is 24D2189199 for a "skilled nursing facility/nursing facility" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria..

This NPI record was last updated on October 27, 2016. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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