Healthcare Provider Details

I. General information

NPI: 1447646724
Provider Name (Legal Business Name): TURTLE MOUNTAIN MATERNAL CHILD HEALTH PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 04/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BUILDING 150 JOHN NORQUAY STREET
BELCOURT ND
58316
US

IV. Provider business mailing address

PO BOX 900
BELCOURT ND
58316-0900
US

V. Phone/Fax

Practice location:
  • Phone: 701-477-0927
  • Fax: 701-477-8785
Mailing address:
  • Phone: 701-477-0927
  • Fax: 701-477-8785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: LAURIE K DAVIS
Title or Position: CASE MANAGER
Credential:
Phone: 701-477-0927