Healthcare Provider Details

I. General information

NPI: 1487358537
Provider Name (Legal Business Name): TURTLE MOUNTAIN MIKINAAK ODE SHELTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 04/03/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3061 HWY 281 UNIT 106
DUNSEITH ND
58329
US

IV. Provider business mailing address

PO BOX 395 3061 HWY 281 UNIT 106
DUNSEITH ND
58329
US

V. Phone/Fax

Practice location:
  • Phone: 701-244-2419
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MELISSA ANDERSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 701-244-2419