Organization
LAKE SUPERIOR COMMUNITY HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEE HOMAN (CEO)
(715) 392-1955
Entity
Organization
Contact information
Practice address
2222 E 5TH ST, SUPERIOR, WI 54880-3709
(715) 392-1955
(715) 392-1935
Mailing address
2222 E 5TH ST, SUPERIOR, WI 54880-3709
(715) 392-1955
(715) 392-1935
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
11/18/2011
Last updated
02/13/2024
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