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Organization
LAKELAND CARE INC
Active
Organization
LAKELAND CARE INC
Active
Other names
Creative Care Options FDL County
Organization subpart
No
Provider details
NPI number
Authorized official
KIM M MICKLE (COMPLIANCE MANAGER)
(920) 906-5100
Entity
Organization
Contact information
Practice address
N6654 ROLLING MEADOWS DR, FOND DU LAC, WI 54937-9471
(920) 906-5100
Mailing address
N6654 ROLLING MEADOWS DR, FOND DU LAC, WI 54937-9471
(920) 906-5100
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
69005500
—
WI
05
—
69005530
—
WI
05
—
69105530
—
WI
05
—
69205530
—
WI
Enumeration date
04/03/2007
Last updated
01/04/2017
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