Provider Demographics
NPI:1033724653
Name:TURTLE MOUNTAIN BAND OF CHIPPEWA INDIANS
Entity Type:Organization
Organization Name:TURTLE MOUNTAIN BAND OF CHIPPEWA INDIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH EDUCATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JAY
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:701-477-5333
Mailing Address - Street 1:PO BOX 900
Mailing Address - Street 2:
Mailing Address - City:BELCOURT
Mailing Address - State:ND
Mailing Address - Zip Code:58316-0900
Mailing Address - Country:US
Mailing Address - Phone:701-477-7929
Mailing Address - Fax:
Practice Address - Street 1:1023 CHIEF LITTLE SHELL STREET NE
Practice Address - Street 2:
Practice Address - City:BELCOURT
Practice Address - State:ND
Practice Address - Zip Code:58316-0900
Practice Address - Country:US
Practice Address - Phone:701-477-7929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TURTLE MOUNTAIN BAND OF CHIPPEWA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management