Provider Demographics
NPI:1144581398
Name:BAD RIVER HONORING OUR CHILDREN
Entity type:Organization
Organization Name:BAD RIVER HONORING OUR CHILDREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHS ADMINISTRATOR/CLINIC BILLING
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-682-7137
Mailing Address - Street 1:53585 NOKOMIS RD
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-4272
Mailing Address - Country:US
Mailing Address - Phone:715-682-7137
Mailing Address - Fax:715-685-7857
Practice Address - Street 1:53585 NOKOMIS RD
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-4272
Practice Address - Country:US
Practice Address - Phone:715-682-7137
Practice Address - Fax:715-685-7857
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAD RIVER BAND OF LAKE SUPERIOR CHIPPEWA INDIANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management