MEDICARE: NETWORK FOR NATIVE FUTURES

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility

General Provider Information

NPI Number	:	1710197207
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NETWORK FOR NATIVE FUTURES

Provider Business Mailing Address
First Line	:	PO BOX 741
Second Line	:
City	:	CASS LAKE
State	:	MN
Zip	:	56633-0741
Country	:	US
Telephone Number	:	218-766-6718
Fax Number	:	218-335-6749

Provider Business Practice Location Address
First Line	:	6781 160TH ST NW
Second Line	:
City	:	CASS LAKE
State	:	MN
Zip	:	56633-3049
Country	:	US
Telephone Number	:	218-766-6718
Fax Number	:	218-335-6749

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. BRIAN MYERS
Credential	:
Telephone Number	:	218-766-6718

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	10/11/2007

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