Lac Du Flambeau Band Of Lake Superior Chippewa Indians
Clinic/Center, Mental Health (Including Community Mental Health Center) in Lac Du Flambeau, WI. Organization (NPI-2).
NPI number1669970729
StatusActive
Last updated in NPPESSep 13, 2018
Details
- NPI
- 1669970729
- Entity type
- Organization (NPI-2)
- Legal business name
- Lac Du Flambeau Band Of Lake Superior Chippewa Indians
- Organization subpart
- No
- Enumeration date
- Jan 24, 2018
- Last updated
- Sep 13, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM0801X | Clinic/Center, Mental Health (Including Community Mental Health Center) | – | – | Yes |
| 261QF0400X | Clinic/Center, Federally Qualified Health Center (FQHC) | – | WI | |
| 324500000X | Substance Abuse Rehabilitation Facility | 3100 | WI |
Other names
- Gookomis Endaad (Doing Business As)
Practice location
3378 N. Schilleman RdLac Du Flambeau, WI 54538-0815
Phone 715-388-0762 · Fax 715-588-1889
Mailing address
Po Box 815Lac Du Flambeau, WI 54538-0815
Phone 715-588-4422 · Fax 715-588-1889
Authorized official
Pamela Ahlborn
Compliance & Contract Coordinator
7155884422
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