Organization
WHITE EARTH BAND OF CHIPPEWA
Active
Other names
White Earth Chemical Dependency Program
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PATRICIA MORAN LADC (CHEMICAL DEPENDENCY COORDINATOR)
(219) 983-3285
Entity
Organization
Contact information
Practice address
35708 CTY HWY 21, WHITE EARTH, MN 56591
(218) 983-3285
(218) 983-3729
Mailing address
PO BOX 435, WHITE EARTH, MN 56591-0435
(218) 983-3285
(218) 983-3729
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3A25WH
BCBS OF MN
MN
Enumeration date
09/07/2006
Last updated
08/22/2020
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