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
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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