LAC DU FLAMBEAU BAND OF LAKE SUPERIOR CHIPPEWA INDIANS NPI 1669970729

NPI Information

NPI: 1669970729
Provider Name: LAC DU FLAMBEAU BAND OF LAKE SUPERIOR CHIPPEWA INDIANS

Doing Business As: GOOKOMIS ENDAAD

Classification: Clinic/Center - 261QM0801X
Entity Type: Organization

Specialization: Mental Health (Including Community Mental Health Center)

Address:
3378 N. SCHILLEMAN RD
LAC DU FLAMBEAU, WI
ZIP 54538
Phone: (715) 388-0762
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LAC DU FLAMBEAU BAND OF LAKE SUPERIOR CHIPPEWA INDIANS is a mental health (including community mental health center) clinic center in Lac Du Flambeau, WI. LAC DU FLAMBEAU BAND OF LAKE SUPERIOR CHIPPEWA INDIANS NPI is 1669970729. The provider is registered as an organization entity type.
The provider Is Doing Business As Gookomis Endaad.

The provider's business location address is:

3378 N. SCHILLEMAN RD
LAC DU FLAMBEAU, WI
ZIP 54538-815
Phone: (715) 388-0762
Fax: (715) 588-1889

The provider's authorized official is Pamela Ahlborn .
The authorized official title is Compliance & Contract Coordinator and has the following contact phone number (715) 588-4422.

The enumeration date for this NPI number is 1/24/2018 and was last updated on 9/13/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)		WISCONSIN	No
2	324500000X	Substance Abuse Rehabilitation Facility		3100	WISCONSIN	No
3	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)			Yes

What is NPI?

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This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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