Provider Demographics
NPI: | 1003261884 |
---|---|
Name: | MHA NATION HOME HEALTH CARE |
Entity type: | Organization |
Organization Name: | MHA NATION HOME HEALTH CARE |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | TRIBAL HEALTH ADMINISTRATOR |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | DEBORAH |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | THOMPSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | RN, BSN, MBA |
Authorized Official - Phone: | 701-627-6616 |
Mailing Address - Street 1: | 404 FRONTAGE RD |
Mailing Address - Street 2: | TRIBAL HEALTH |
Mailing Address - City: | NEW TOWN |
Mailing Address - State: | ND |
Mailing Address - Zip Code: | 58763-9404 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1 MINNI TOHE DR |
Practice Address - Street 2: | |
Practice Address - City: | NEW TOWN |
Practice Address - State: | ND |
Practice Address - Zip Code: | 58763-4400 |
Practice Address - Country: | US |
Practice Address - Phone: | 701-627-6618 |
Practice Address - Fax: | 701-627-4004 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | THREE AFFILIATED TRIBES |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2016-04-28 |
Last Update Date: | 2016-04-28 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 163WH0200X | Nursing Service Providers | Registered Nurse | Home Health | Group - Single Specialty |