Provider Demographics
NPI:1366195133
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:HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-983-3286
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:
Mailing Address - Fax:
Practice Address - Street 1:2515 WORKFORCE CENTER ROAD
Practice Address - Street 2:
Practice Address - City:MAHNOMEN
Practice Address - State:MN
Practice Address - Zip Code:56557
Practice Address - Country:US
Practice Address - Phone:218-935-5554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WHITE EARTH BAND OF CHIPPWA INDIANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management