Provider Demographics
NPI:1194961276
Name:WHITE EARTH OSHKI MANIDOO NEW SPIRIT CENTER
Entity type:Organization
Organization Name:WHITE EARTH OSHKI MANIDOO NEW SPIRIT CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:HEWITT
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:218-751-6553
Mailing Address - Street 1:1741 15TH ST NW
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-8755
Mailing Address - Country:US
Mailing Address - Phone:218-751-6553
Mailing Address - Fax:218-751-1846
Practice Address - Street 1:1741 15TH ST NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-8755
Practice Address - Country:US
Practice Address - Phone:218-751-6553
Practice Address - Fax:218-751-1846
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WHITE EARTH RESERVATION TRIBAL COUNCIL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-19
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10526793245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children