Provider Demographics
NPI:1780708107
Name:LOWER SIOUX INDIAN COMMUNITY
Entity type:Organization
Organization Name:LOWER SIOUX INDIAN COMMUNITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TRIBAL ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GABRIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:STRONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-697-6185
Mailing Address - Street 1:39458 RESERVATION HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:MN
Mailing Address - Zip Code:56270-1252
Mailing Address - Country:US
Mailing Address - Phone:507-697-6288
Mailing Address - Fax:
Practice Address - Street 1:39458 RESERVATION HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:MN
Practice Address - Zip Code:56270-1252
Practice Address - Country:US
Practice Address - Phone:507-697-6288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN901477200OtherTAX ID