Provider Demographics
NPI:1427309368
Name:OGLALA SIOUX TRIBE
Entity type:Organization
Organization Name:OGLALA SIOUX TRIBE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:E
Authorized Official - Last Name:LONE ELK
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:605-867-1704
Mailing Address - Street 1:PO BOX 5011
Mailing Address - Street 2:EAST HIWAY 18 AIRPORT ROAD
Mailing Address - City:PINE RIDGE
Mailing Address - State:SD
Mailing Address - Zip Code:57770-5011
Mailing Address - Country:US
Mailing Address - Phone:605-867-1704
Mailing Address - Fax:605-867-2063
Practice Address - Street 1:EAST HIGHWAY 18 AIRPORT ROAD
Practice Address - Street 2:OGLALA SIOUX TRIBE OST HEALTH ADMINISTRATION
Practice Address - City:PINE RIDGE
Practice Address - State:SD
Practice Address - Zip Code:57770-5011
Practice Address - Country:US
Practice Address - Phone:605-867-1704
Practice Address - Fax:605-867-2063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health