NPIMap

Organization Active NPI

Little River Band of Ottawa Indians

  • Federally Qualified Health Center (FQHC)
  • Manistee, MI
National Provider Identifier
1154590917
Registry record updated Mar 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
23-1870 Issued in MI
Legal business name
LITTLE RIVER BAND OF OTTAWA INDIANS
Practice address
2608 Government Center Dr
Manistee, MI 49660-8302
Phone
(231) 723-8299
Fax
(231) 398-9684
NPI assigned
Feb 26, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Janice Grant
Title
Health Services Supervisor
Phone
(231) 723-8299

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 23-1870 MI Primary

Addresses

Primary practice location

2608 Government Center Dr
Manistee, MI 49660-8302

Mailing address

2608 Government Center Dr
Manistee, MI 49660-8302
Phone (231) 723-8299

Other identifiers 1

IdentifierTypeStateIssuer
080E110030OtherBCBSMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080721000073 MI Part A Provider - Federally Qualified Health Center (FQHC) 0547333841 Practice locations: Manistee, MI

Federally qualified health center certification: CCN 231870

Legal name
LITTLE RIVER BAND OF OTTAWA INDIANS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 25, 2000
Last certification
Jan 25, 2000
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Enrollment address
2608 Government Center Dr
Manistee, MI 49660-8302

National Provider Directory

National Provider Directory
Tax ID family
Little River Band of Ottawa Indians6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

310 9th St
Manistee, MI 49660
Phone (231) 398-6630

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Little River Band of Ottawa Indians Organization, Manistee, MI Non-profit 5% Or Greater Direct Ownership Interest Jan 25, 2000 100%
Larry Romanelli Individual Corporate OfficerTribal Ogema Aug 13, 2020
Steven Wheeler Individual W-2 Managing EmployeeCfo Jan 1, 2008

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1203984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458604800000",
    "number": "1154590917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2608 GOVERNMENT CENTER DR",
            "city": "MANISTEE",
            "state": "MI",
            "postal_code": "496608302",
            "telephone_number": "231-723-8299",
            "fax_number": "231-398-9684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2608 GOVERNMENT CENTER DR",
            "city": "MANISTEE",
            "state": "MI",
            "postal_code": "496608302",
            "telephone_number": "231-723-8299",
            "fax_number": "231-398-9684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LITTLE RIVER BAND OF OTTAWA INDIANS",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-26",
        "last_updated": "2016-03-22",
        "status": "A",
        "authorized_official_last_name": "GRANT",
        "authorized_official_first_name": "JANICE",
        "authorized_official_title_or_position": "HEALTH SERVICES SUPERVISOR",
        "authorized_official_telephone_number": "231-723-8299"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "MI",
            "license": "23-1870",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSMI",
            "identifier": "080E110030",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Manistee, MI

Sources for this page

Verify at the official NPI Registry.