Organization
BAY MILLS INDIAN COMMUNITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AUDREY BREAKIE (HHS DIRECTOR)
(906) 248-8327
Entity
Organization
Contact information
Practice address
12455 W LAKESHORE DR, BRIMLEY, MI 49715-9319
(906) 248-5527
(906) 248-5765
Mailing address
12455 W LAKESHORE DR, BRIMLEY, MI 49715-9319
(906) 248-5527
(906) 248-2496
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1073711057
—
MI
01
—
MI9748
MEDICARE
MI
Enumeration date
07/11/2007
Last updated
06/09/2022
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