Healthcare Provider Details

I. General information

NPI: 1780787978
Provider Name (Legal Business Name): WHITE EARTH BAND OF CHIPPEWA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2531 310TH AVE
NAYTAHWAUSH MN
56566-9998
US

IV. Provider business mailing address

PO BOX 70
NAYTAHWAUSH MN
56566-0070
US

V. Phone/Fax

Practice location:
  • Phone: 218-935-5554
  • Fax: 218-935-2593
Mailing address:
  • Phone: 218-935-5554
  • Fax: 218-935-2593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateMN

VIII. Authorized Official

Name: JERI JASKEN
Title or Position: INDIAN CHILD WELFARE MANAGER
Credential:
Phone: 218-935-5554