Provider Demographics
NPI:1730703984
Name:TURTLE MOUNTAIN BAND OF CHIPPEWA INDIANS
Entity type:Organization
Organization Name:TURTLE MOUNTAIN BAND OF CHIPPEWA INDIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:AZURE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-477-2673
Mailing Address - Street 1:1105 SHELDON SOURAY AVENUE
Mailing Address - Street 2:P.O. BOX 520
Mailing Address - City:BELCOURT
Mailing Address - State:ND
Mailing Address - Zip Code:58316-0520
Mailing Address - Country:US
Mailing Address - Phone:701-477-3121
Mailing Address - Fax:701-477-8925
Practice Address - Street 1:1105 SHELDON SOURAY AVENUE
Practice Address - Street 2:
Practice Address - City:BELCOURT
Practice Address - State:ND
Practice Address - Zip Code:58316-0520
Practice Address - Country:US
Practice Address - Phone:701-477-3121
Practice Address - Fax:701-477-8925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility