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General NPI Number Information
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NPI Number | 1649295502
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Entity Type | Organization
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Legal Business Name | WHITE EARTH BAND OF CHIPPEWA
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 07/28/2010
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Provider Practice Location Address
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Address Line | 26246 CRANE RD
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City | WHITE EARTH
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State | MN
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Zip | 56591-9998
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Country | US
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Telephone | 218-983-3285
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Fax | 218-983-3742
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Provider Business Mailing Address
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Address Line | PO BOX 496 26246 CRANE RD
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City | WHITE EARTH
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State | MN
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Zip | 56591-0496
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Country | US
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Telephone | 218-983-3285
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Fax | 218-983-3724
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Authorized Official
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Title or Position | PHN-MANAGER
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Name | PATRICIA A BUTLER
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Credential | RN, BSN, PHN
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Telephone | 218-983-3285
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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 | 330865
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License Number State | MN
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