Healthcare Provider Details

I. General information

NPI: 1790942035
Provider Name (Legal Business Name): THREE AFFILIATED TRIBES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MINNI TOHE DR
NEW TOWN ND
58763-4400
US

IV. Provider business mailing address

404 FRONTAGE RD
NEW TOWN ND
58763-9404
US

V. Phone/Fax

Practice location:
  • Phone: 701-627-7910
  • Fax: 701-627-4318
Mailing address:
  • Phone: 701-421-7901
  • Fax: 701-627-4318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STELLA BERQUIST
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: R.N.
Phone: 701-627-7910