Organization Name: | CHEROCREEK NATION |
NPI Number: | 1598184087 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MINA CARABALLO (OWNER ADMINISTRATOR) |
Mailing Address: | 831 Talent Ave Talent |
State: | OR US |
Postal Code: | 975409613 |
Phone Number: | 5413939060 |
Fax Number: | |
NPI Enumeration Date: | 04/11/2014 |
NPI Last Update Date: | 04/11/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 251K00000X |
License Number: | 002495302 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Agencies |
Taxonomy Classification: | Public Health or Welfare |
Taxonomy Specialization: | |
Taxonomy Definition: |