Provider Demographics
NPI:1154587129
Name:MILLE LACS BAND FAMILY SERVICES
Entity type:Organization
Organization Name:MILLE LACS BAND FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTAKE, REFERRAL, AND OFFICE COORD.
Authorized Official - Prefix:
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LEBLANC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-532-7764
Mailing Address - Street 1:17230 NOOPIMING DR
Mailing Address - Street 2:
Mailing Address - City:ONAMIA
Mailing Address - State:MN
Mailing Address - Zip Code:56359-4522
Mailing Address - Country:US
Mailing Address - Phone:320-532-7764
Mailing Address - Fax:320-532-7803
Practice Address - Street 1:17230 NOOPIMING DR
Practice Address - Street 2:
Practice Address - City:ONAMIA
Practice Address - State:MN
Practice Address - Zip Code:56359-4522
Practice Address - Country:US
Practice Address - Phone:320-532-7764
Practice Address - Fax:320-532-7803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management