Organization
LITTLE RIVER BAND OF OTTAWA INDIANS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANICE GRANT (HEALTH SERVICES SUPERVISOR)
(231) 723-8299
Entity
Organization
Contact information
Practice address
2608 GOVERNMENT CENTER DR, MANISTEE, MI 49660-8302
(231) 723-8299
(231) 398-9684
Mailing address
2608 GOVERNMENT CENTER DR, MANISTEE, MI 49660-8302
(231) 723-8299
(231) 398-9684
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
23-1870
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080E110030
BCBSMI
—
Enumeration date
02/26/2008
Last updated
03/22/2016
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