Organization Name: | MATCH-E-BE-NASH-SHE-WISH BAND OF POTTAWATOMI INDIANS |
NPI Number: | 1952685588 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | PHYLLIS ANN DAVIS (HEALTH DIRECTOR) |
Mailing Address: | 1743 142nd Ave Ste 9 Dorr |
State: | MI US |
Postal Code: | 493238031 |
Phone Number: | 6166810360 |
Fax Number: | 6166810374 |
NPI Enumeration Date: | 09/30/2011 |
NPI Last Update Date: | 03/18/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QC1500X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Community Health |
Taxonomy Definition: |