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General NPI Number Information
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NPI Number | 1043477656
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Entity Type | Organization
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Legal Business Name | MILLE LACS BAND OF OJIBWE PUBLIC HEALTH
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Dates
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Enumeration Date | 05/21/2008
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Last Update Date | 08/18/2020
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Provider Practice Location Address
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Address Line | 18562 MINOBIMAADIZI LOOP
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City | ONAMIA
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State | MN
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Zip | 56359-3001
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Country | US
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Telephone | 320-532-7776
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Fax | 320-532-7524
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Provider Business Mailing Address
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Address Line | 18562 MINOBIMAADIZI LOOP
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City | ONAMIA
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State | MN
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Zip | 56359-3001
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Country | US
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Telephone | 320-532-7776
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Fax | 320-532-7524
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Authorized Official
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Title or Position | COMMISSIONER OF HEALTH & HUMAN SERV
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Name | NICOLE ANDERSON
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Credential |
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Telephone | 320-532-4163
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 339079
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License Number State | MN
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