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General NPI Number Information
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NPI Number | 1316806581
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Entity Type | Organization
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Legal Business Name | HANNAHVILLE INDIAN COMMUNITY
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Dates
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Enumeration Date | 01/21/2026
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Last Update Date | 01/28/2026
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Provider Practice Location Address
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Address Line | 3071 D RD
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City | BARK RIVER
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State | MI
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Zip | 49807-8702
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Country | US
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Telephone | 906-280-5004
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Fax |
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Provider Business Mailing Address
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Address Line | 3071 D RD
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City | BARK RIVER
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State | MI
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Zip | 49807-8702
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Country | US
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Telephone | 906-280-5004
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Fax |
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Authorized Official
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Title or Position | PROGRAM SUPERVISOR
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Name | MRS. ALICIA MARIE BERTRAND
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Credential | CPRM, CHW
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Telephone | 906-280-5004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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