Provider Demographics
NPI:1134260649
Name:EASTERN BAND OF CHEROKEE INDIANS
Entity type:Organization
Organization Name:EASTERN BAND OF CHEROKEE INDIANS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNAB
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:828-359-6872
Mailing Address - Street 1:PO BOX 365
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE
Mailing Address - State:NC
Mailing Address - Zip Code:28719-0365
Mailing Address - Country:US
Mailing Address - Phone:828-359-6872
Mailing Address - Fax:828-359-0406
Practice Address - Street 1:73 KAISER WILNOTY DRIVE
Practice Address - Street 2:
Practice Address - City:CHEROKEE
Practice Address - State:NC
Practice Address - Zip Code:28719-0365
Practice Address - Country:US
Practice Address - Phone:828-359-6872
Practice Address - Fax:828-520-1172
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EASTERN BAND OF CHEROKEE INDIANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-08
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3407101Medicaid
347101Medicare Oscar/Certification
NC347101Medicare Oscar/Certification
NC347101Medicare PIN