Provider Demographics
NPI:1194975136
Name:WHITE EARTH HEALTHCARE CENTER
Entity type:Organization
Organization Name:WHITE EARTH HEALTHCARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COTA/L
Authorized Official - Prefix:MISS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:INGRID
Authorized Official - Last Name:HUSBY
Authorized Official - Suffix:
Authorized Official - Credentials:COTA/L
Authorized Official - Phone:218-983-4300
Mailing Address - Street 1:28920 COUNTY ROAD 110
Mailing Address - Street 2:
Mailing Address - City:CALLAWAY
Mailing Address - State:MN
Mailing Address - Zip Code:56521-9642
Mailing Address - Country:US
Mailing Address - Phone:218-375-2115
Mailing Address - Fax:
Practice Address - Street 1:40520 COUNTY HIGHWAY 34
Practice Address - Street 2:
Practice Address - City:OGEMA
Practice Address - State:MN
Practice Address - Zip Code:56569-9612
Practice Address - Country:US
Practice Address - Phone:218-983-6200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN201299261QR0400X
FL10147261QR0400X
AZ3661261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation