Provider Demographics
NPI:1205243565
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:GRANT CLEARINGHOUSE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TWILA
Authorized Official - Middle Name:M
Authorized Official - Last Name:JEROME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-477-2648
Mailing Address - Street 1:PO BOX 900
Mailing Address - Street 2:4180 HIGHWAY 281 W
Mailing Address - City:BELCOURT
Mailing Address - State:ND
Mailing Address - Zip Code:58316-0900
Mailing Address - Country:US
Mailing Address - Phone:701-477-2600
Mailing Address - Fax:701-477-2705
Practice Address - Street 1:4180 HIGHWAY 281 W
Practice Address - Street 2:
Practice Address - City:BELCOURT
Practice Address - State:ND
Practice Address - Zip Code:58316-0900
Practice Address - Country:US
Practice Address - Phone:701-477-2600
Practice Address - Fax:701-477-2705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-18
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No347C00000XTransportation ServicesPrivate VehicleGroup - Multi-Specialty