Provider Demographics
NPI:1144768409
Name:NORTHERN ARAPAHO TRIBAL HEALTH PROGRAMS
Entity Type:Organization
Organization Name:NORTHERN ARAPAHO TRIBAL HEALTH PROGRAMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHR SUPERVISER PROGRAM ADMINISTRAT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:A
Authorized Official - Last Name:WHITEHURST
Authorized Official - Suffix:
Authorized Official - Credentials:RN-RAC
Authorized Official - Phone:307-332-6836
Mailing Address - Street 1:PO BOX 860
Mailing Address - Street 2:
Mailing Address - City:FORT WASHAKIE
Mailing Address - State:WY
Mailing Address - Zip Code:82514-0860
Mailing Address - Country:US
Mailing Address - Phone:307-332-6836
Mailing Address - Fax:307-335-7274
Practice Address - Street 1:643 BLUE SKY HIGHWAY
Practice Address - Street 2:
Practice Address - City:ETHETE
Practice Address - State:WY
Practice Address - Zip Code:82520-0000
Practice Address - Country:US
Practice Address - Phone:307-332-6836
Practice Address - Fax:307-335-7274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-07
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management