Organization
FOND DU LAC RESERVATION BUSINESS COMMITTEE
Active
Organization
FOND DU LAC RESERVATION BUSINESS COMMITTEE
Active
Other names
Fond du Lac Human Services Division
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARILYN GROVER (ASSOCIATE DIRECTOR)
(218) 879-1227
Entity
Organization
Contact information
Practice address
927 TRETTLE LANE, FOND DU LAC HUMAN SERVICES DIVISION, CLOQUET, MN 55720
(218) 879-1227
(218) 878-3800
Mailing address
927 TRETTLE LANE, FOND DU LAC HUMAN SERVICES DIVISION, CLOQUET, MN 55720
(218) 879-1227
(218) 878-3800
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
MN
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
012003
MN
332B00000X
Durable Medical Equipment & Medical Supplies
5985000001
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
666815100
—
MN
05
—
666815101
—
MN
01
—
8F27FO
BCBS AODA
MN
Enumeration date
07/30/2006
Last updated
02/02/2016
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