Provider Demographics
NPI:1336535038
Name:TURLTE MOUNTAIN MATERNAL CHILD HEALTH PROGRAM
Entity Type:Organization
Organization Name:TURLTE MOUNTAIN MATERNAL CHILD HEALTH PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-477-0927
Mailing Address - Street 1:PO BOX 900
Mailing Address - Street 2:
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:701-477-8785
Practice Address - Street 1:BUILDING 150 JOHN NORQUAY STREET
Practice Address - Street 2:
Practice Address - City:BELCOURT
Practice Address - State:ND
Practice Address - Zip Code:58316
Practice Address - Country:US
Practice Address - Phone:701-477-0927
Practice Address - Fax:701-477-8785
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TURTLE MOUNTAIN BAND OF CHIPPEWA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management