Organization
BAD RIVER BAND OF LAKE SUPERIOR TRIBE OF CHIPPEWA INDAINS WIS
Active
Parent organization
BAD RIVER BAND OF LAKE SUPERIOR TRIBE OF CHIPPEWA INDIANS WIS
Other names
Bad River AODA Behavioral Health
Organization subpart
Yes
Provider details
NPI number
Legal business name
BAD RIVER BAND OF LAKE SUPERIOR TRIBE OF CHIPPEWA INDIANS WIS
Authorized official
MRS. DEBRA A TUTOR (CLINIC ADMINISTRATOR)
(715) 682-7133
Entity
Organization
Contact information
Practice address
53585 NOKOMIS RD, ASHLAND, WI 54806-4272
(715) 682-7133
(715) 685-7857
Mailing address
53585 NOKOMIS RD, ASHLAND, WI 54806-4272
(715) 682-7133
(715) 685-7857
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
2728
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42202100
—
WI
Enumeration date
05/07/2008
Last updated
02/08/2017
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