Provider Demographics
NPI:1568716090
Name:NORTHERN CHEYENNE TRIBE
Entity Type:Organization
Organization Name:NORTHERN CHEYENNE TRIBE
Other - Org Name:NORTHERN CHEYENNE TRIBAL BOARD OF HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF REVENUE ENHANCEMENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUNDSTONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-477-6722
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:600 CHEYENNE AVE SOUTH
Mailing Address - City:LAME DEER
Mailing Address - State:MT
Mailing Address - Zip Code:59043-0128
Mailing Address - Country:US
Mailing Address - Phone:406-477-6722
Mailing Address - Fax:406-477-8621
Practice Address - Street 1:420 NORTH CHEYENNE AVENUE
Practice Address - Street 2:LAME DEER HEALTH CENTER - BEHAVIOR HEALTH
Practice Address - City:LAME DEER
Practice Address - State:MT
Practice Address - Zip Code:59043
Practice Address - Country:US
Practice Address - Phone:406-477-4514
Practice Address - Fax:406-477-4513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-06
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT321061Medicaid