Provider Demographics
NPI:1033597513
Name:MINNESOTA INDIAN WOMEN'S RESOURCE CENTER
Entity Type:Organization
Organization Name:MINNESOTA INDIAN WOMEN'S RESOURCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JONI
Authorized Official - Middle Name:
Authorized Official - Last Name:BUFFALOHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:612-724-2124
Mailing Address - Street 1:2300 15TH AVENUE SOUTH
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404
Mailing Address - Country:US
Mailing Address - Phone:612-724-2124
Mailing Address - Fax:612-728-2039
Practice Address - Street 1:2300 15TH AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3960
Practice Address - Country:US
Practice Address - Phone:612-724-2124
Practice Address - Fax:612-728-2039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-15
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8015573CDT324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility