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Organization
LAC DU FLAMBEAU BAND OF LAKE SUPERIOR CHIPPEWA INDIANS
Active
Organization
LAC DU FLAMBEAU BAND OF LAKE SUPERIOR CHIPPEWA INDIANS
Active
Other names
Gookomis Endaad
Organization subpart
No
Provider details
NPI number
Authorized official
PAMELA AHLBORN (COMPLIANCE & CONTRACT COORDINATOR)
(715) 588-4422
Entity
Organization
Contact information
Practice address
3378 N. SCHILLEMAN RD, LAC DU FLAMBEAU, WI 54538-0815
(715) 388-0762
(715) 588-1889
Mailing address
PO BOX 815, LAC DU FLAMBEAU, WI 54538-0815
(715) 588-4422
(715) 588-1889
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
—
WI
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
324500000X
Substance Abuse Rehabilitation Facility
3100
WI
Other
Enumeration date
01/24/2018
Last updated
09/13/2018
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