Provider Demographics
NPI:1679239172
Name:STANDING ROCK SIOUX TRIBE
Entity Type:Organization
Organization Name:STANDING ROCK SIOUX TRIBE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ARIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:IRONBOULDER
Authorized Official - Suffix:
Authorized Official - Credentials:LBSW
Authorized Official - Phone:701-854-3752
Mailing Address - Street 1:PO BOX D
Mailing Address - Street 2:
Mailing Address - City:FORT YATES
Mailing Address - State:ND
Mailing Address - Zip Code:58538-0522
Mailing Address - Country:US
Mailing Address - Phone:701-854-3752
Mailing Address - Fax:
Practice Address - Street 1:125 S RIVER ROAD
Practice Address - Street 2:
Practice Address - City:FORT YATES
Practice Address - State:ND
Practice Address - Zip Code:58538
Practice Address - Country:US
Practice Address - Phone:701-854-3752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STANDING ROCK SIOUX TRIBE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management