Provider Demographics
NPI:1366643694
Name:SAULT TRIBE OF CHIPPEWA INDIANS
Entity type:Organization
Organization Name:SAULT TRIBE OF CHIPPEWA INDIANS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH DIVISION DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:CULFA
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN
Authorized Official - Phone:906-632-5275
Mailing Address - Street 1:4935 ZEE BA TIK LN
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:MI
Mailing Address - Zip Code:49868-8188
Mailing Address - Country:US
Mailing Address - Phone:906-293-8181
Mailing Address - Fax:906-293-3001
Practice Address - Street 1:4935 ZEE BA TIK LN
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:MI
Practice Address - Zip Code:49868-8188
Practice Address - Country:US
Practice Address - Phone:906-293-8181
Practice Address - Fax:906-293-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)