# LAKELAND CARE INC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Creative Care Options FDL County
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366563314
- **Authorized official:** KIM M MICKLE (COMPLIANCE MANAGER)
- **Authorized official phone:** (920) 906-5100

## Contact information

- **Practice address:** N6654 ROLLING MEADOWS DR, FOND DU LAC, WI 54937-9471
- **Practice address phone:** (920) 906-5100
- **Mailing address:** N6654 ROLLING MEADOWS DR, FOND DU LAC, WI 54937-9471
- **Mailing address phone:** (920) 906-5100

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302F00000X | Exclusive Provider Organization | — | NULL | Yes |

## Other

- **Enumeration date:** 04/03/2007
- **Last updated:** 01/04/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 69005500 | — | WI |
| 05 | — | 69005530 | — | WI |
| 05 | — | 69105530 | — | WI |
| 05 | — | 69205530 | — | WI |