Provider Demographics
NPI:1457639551
Name:WHITE EARTH BAND OF OJIBWE - INDIAN CHILD WELFARE
Entity Type:Organization
Organization Name:WHITE EARTH BAND OF OJIBWE - INDIAN CHILD WELFARE
Other - Org Name:DREAM CATCHER HOMES SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:CHILD WELFARE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JERI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:JASKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-983-4647
Mailing Address - Street 1:301 FEATHER STREET
Mailing Address - Street 2:
Mailing Address - City:OGEMA
Mailing Address - State:MN
Mailing Address - Zip Code:56569
Mailing Address - Country:US
Mailing Address - Phone:218-983-3011
Mailing Address - Fax:218-983-3002
Practice Address - Street 1:301 FEATHER STREET
Practice Address - Street 2:
Practice Address - City:OGEMA
Practice Address - State:MN
Practice Address - Zip Code:56569
Practice Address - Country:US
Practice Address - Phone:218-983-3011
Practice Address - Fax:218-983-3002
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WHITE EARTH BAND OF OJIBWE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-25
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0086101YP2500X
MN144861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty