Lac Du Flambeau Band of Lake Superior Chippewa Indians
NPI #1669970729 in Lac Du Flambeau, Wisconsin
Provider Information
- NPI Number
- 1669970729
- Entity Type
- Organization
- Organization Name
- Lac Du Flambeau Band of Lake Superior Chippewa Indians
- Primary Specialty
- Clinic/Center - Mental Health (Including Community Mental Health Center)
- Enumeration Date
- Jan 24, 2018
- Last Updated
- Sep 13, 2018
Practice Location
- Address
- 3378 N. SCHILLEMAN RD
- City
- Lac Du Flambeau
- State
- Wisconsin
- ZIP Code
- 54538-0815
- Phone
- (715) 388-0762
Authorized Official
- Name
- PAMELA AHLBORN
- Title
- COMPLIANCE & CONTRACT COORDINATOR
- Phone
- (715) 588-4422
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Federally Qualified Health Center (FQHC) — Federally Qualified Health Center (FQHC) |
| Substance Abuse Rehabilitation Facility |
| Clinic/Center - Mental Health (Including Community Mental Health Center) — Mental Health (Including Community Mental Health Center) |
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