Provider Demographics
NPI:1013041698
Name:SAGINAW CHIPPEWA INDIAN TRIBE BEHAVIORAL HEALTH PROGRAM
Entity Type:Organization
Organization Name:SAGINAW CHIPPEWA INDIAN TRIBE BEHAVIORAL HEALTH PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIORAL HEALTH ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HUNTER
Authorized Official - Middle Name:
Authorized Official - Last Name:GENIA
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:989-775-4850
Mailing Address - Street 1:2800 S SHEPHERD RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-8966
Mailing Address - Country:US
Mailing Address - Phone:989-775-4850
Mailing Address - Fax:989-775-4851
Practice Address - Street 1:2800 S SHEPHERD RD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-8966
Practice Address - Country:US
Practice Address - Phone:989-775-4850
Practice Address - Fax:989-775-4851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI370007261QR0405X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Not Answered324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility