Provider Demographics
NPI:1780787978
Name:WHITE EARTH BAND OF CHIPPEWA
Entity type:Organization
Organization Name:WHITE EARTH BAND OF CHIPPEWA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INDIAN CHILD WELFARE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JERI
Authorized Official - Middle Name:
Authorized Official - Last Name:JASKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-935-5554
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:NAYTAHWAUSH
Mailing Address - State:MN
Mailing Address - Zip Code:56566-0070
Mailing Address - Country:US
Mailing Address - Phone:218-935-5554
Mailing Address - Fax:218-935-2593
Practice Address - Street 1:2531 310TH AVE
Practice Address - Street 2:
Practice Address - City:NAYTAHWAUSH
Practice Address - State:MN
Practice Address - Zip Code:56566-9998
Practice Address - Country:US
Practice Address - Phone:218-935-5554
Practice Address - Fax:218-935-2593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management