Provider Demographics
NPI:1447825146
Name:AMERICAN INDIAN COMMUNITY HOUSING ORGANIZATION
Entity type:Organization
Organization Name:AMERICAN INDIAN COMMUNITY HOUSING ORGANIZATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PROGRAMMING
Authorized Official - Prefix:
Authorized Official - First Name:DARYL
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-722-7225
Mailing Address - Street 1:202 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-1934
Mailing Address - Country:US
Mailing Address - Phone:218-722-7225
Mailing Address - Fax:218-722-4707
Practice Address - Street 1:202 W 2ND ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1934
Practice Address - Country:US
Practice Address - Phone:218-722-7225
Practice Address - Fax:218-722-4707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-25
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health