Provider Demographics
NPI:1073972048
Name:WHITE EARTH BAND OF OJIBWE
Entity Type:Organization
Organization Name:WHITE EARTH BAND OF OJIBWE
Other - Org Name:WHITE EARTH MAT PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BEHAVIORAL HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JERI
Authorized Official - Middle Name:
Authorized Official - Last Name:JASKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-983-4647
Mailing Address - Street 1:26246 CRANE RD
Mailing Address - Street 2:
Mailing Address - City:WHITE EARTH
Mailing Address - State:MN
Mailing Address - Zip Code:56591-9998
Mailing Address - Country:US
Mailing Address - Phone:218-983-3285
Mailing Address - Fax:218-983-4343
Practice Address - Street 1:26246 CRANE RD
Practice Address - Street 2:
Practice Address - City:WHITE EARTH
Practice Address - State:MN
Practice Address - Zip Code:56591-9998
Practice Address - Country:US
Practice Address - Phone:218-983-3285
Practice Address - Fax:218-983-4343
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WHITE EARTH BAND OF OJIBWE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health