Organization
SAULT TRIBE OF CHIPPEWA INDIANS
Active
Parent organization
SAULT TRIBE OF CHIPPEWA INDIANS
Other names
DeTour Village Medical Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
SAULT TRIBE OF CHIPPEWA INDIANS
Authorized official
BONNIE CULFA RN MSN (HEALTH DIRECTOR)
(906) 632-5200
Entity
Organization
Contact information
Practice address
346 SUPERIOR ST, DE TOUR VILLAGE, MI 49725
(906) 297-3204
Mailing address
346 SUPERIOR ST, DE TOUR VILLAGE, MI 49725
(906) 297-3204
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
231875
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
231875
FQHC FACILITY NUMBER
MI
Enumeration date
01/19/2007
Last updated
07/10/2007
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