Provider Demographics
NPI:1861545337
Name:SAULT TRIBE OF CHIPPEWA INDIANS
Entity type:Organization
Organization Name:SAULT TRIBE OF CHIPPEWA INDIANS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CULFA
Authorized Official - Suffix:
Authorized Official - Credentials:RN MSN
Authorized Official - Phone:906-632-5200
Mailing Address - Street 1:346 SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:DE TOUR VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49725
Mailing Address - Country:US
Mailing Address - Phone:906-297-3204
Mailing Address - Fax:
Practice Address - Street 1:346 SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:DE TOUR VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:49725
Practice Address - Country:US
Practice Address - Phone:906-297-3204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAULT TRIBE OF CHIPPEWA INDIANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-19
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
231875261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI231875OtherFQHC FACILITY NUMBER