Organization
FOND DU LAC RESERVATION BUSINESS COMMITTEE
Active
Parent organization
FOND DU LAC HUMAN SERVICES DIVISION
Other names
FDL Adult Outpatient Tx
Organization subpart
Yes
Provider details
NPI number
Legal business name
FOND DU LAC HUMAN SERVICES DIVISION
Authorized official
MS. MARILYN GROVER (ASSOCIATE DIRECTOR)
(218) 879-1227
Entity
Organization
Contact information
Practice address
927 TRETTEL LANE, FOND DU LAC HUMAN SERVICES DIVISION, CLOQUET, MN 55720
(218) 879-1227
(218) 878-3755
Mailing address
927 TRETTEL LANE, FOND DU LAC HUMAN SERVICES DIVISION, CLOQUET, MN 55720
(218) 879-1227
(218) 878-3755
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
012010
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1326053166
—
MN
Enumeration date
02/17/2011
Last updated
10/10/2016
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