Provider Demographics
NPI:1023208774
Name:SAULT TRIBE OF CHIPPEWA INDIANS
Entity Type:Organization
Organization Name:SAULT TRIBE OF CHIPPEWA INDIANS
Other - Org Name:ESCANABA COMMUNITY HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DIVISION OF HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:CULFA
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN
Authorized Official - Phone:906-632-5272
Mailing Address - Street 1:3500 LUDINGTON ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-4216
Mailing Address - Country:US
Mailing Address - Phone:906-786-9211
Mailing Address - Fax:906-786-3338
Practice Address - Street 1:3500 LUDINGTON ST
Practice Address - Street 2:SUITE 210
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-4216
Practice Address - Country:US
Practice Address - Phone:906-786-9211
Practice Address - Fax:906-786-3338
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAULT TRIBE OF CHIPPEWA INDIANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)