Provider Demographics
NPI:1477964757
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:PROJECT COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BIRKLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-477-5688
Mailing Address - Street 1:4051 HWY 281
Mailing Address - Street 2:
Mailing Address - City:BELCOURT
Mailing Address - State:ND
Mailing Address - Zip Code:58316
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4051 HWY 281
Practice Address - Street 2:
Practice Address - City:BELCOURT
Practice Address - State:ND
Practice Address - Zip Code:58316
Practice Address - Country:US
Practice Address - Phone:701-477-5688
Practice Address - Fax:701-477-5797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3242251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management