Organization
SPIRIT LAKE TRIBE
Active
Other names
Spirit Lake Tribe Tiwahe Program
Organization subpart
No
Provider details
NPI number
Authorized official
CARLA CARMONA (PROGRAM MANAGER)
(701) 766-4736
Entity
Organization
Contact information
Practice address
7184 HWY 57, FORT TOTTEN, ND 58335
(701) 766-4736
(701) 766-4722
Mailing address
7184 HWY 57, FORT TOTTEN, ND 58335
(701) 766-4736
(701) 766-4722
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Enumeration date
10/25/2022
Last updated
10/25/2022
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