| Organization Name: | LITTLE RIVER BAND OF OTTAWA INDIANS |
| NPI Number: | 1154590917 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JANICE GRANT (HEALTH SERVICES SUPERVISOR) |
| Mailing Address: | 2608 Government Center Dr Manistee |
| State: | MI US |
| Postal Code: | 496608302 |
| Phone Number: | 2317238299 |
| Fax Number: | 2313989684 |
| NPI Enumeration Date: | 02/26/2008 |
| NPI Last Update Date: | 03/22/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QF0400X |
| License Number: | 23-1870 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
| Taxonomy Definition: | |