Provider Demographics
NPI:1629698303
Name:EASTERN BAND OF CHEROKEE INDIANS
Entity type:Organization
Organization Name:EASTERN BAND OF CHEROKEE INDIANS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HEALTH CARE ADMINISTRAT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ERNEST
Authorized Official - Last Name:QUILLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-359-6194
Mailing Address - Street 1:PO BOX 666
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE
Mailing Address - State:NC
Mailing Address - Zip Code:28719-0666
Mailing Address - Country:US
Mailing Address - Phone:828-359-1507
Mailing Address - Fax:
Practice Address - Street 1:117 JOHN CROWE HILL DR
Practice Address - Street 2:
Practice Address - City:CHEROKEE
Practice Address - State:NC
Practice Address - Zip Code:28719
Practice Address - Country:US
Practice Address - Phone:828-359-1507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EASTERN BAND OF CHEROKEE INDIANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-22
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency