Organization
RED CLIFF AODA PROGRAM/MISHOMIS HOUSE
Active
Organization
RED CLIFF AODA PROGRAM/MISHOMIS HOUSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARTIN A GORDON CSAC/ICS (PROGRAM DIRECTOR)
(715) 779-3741
Entity
Organization
Contact information
Practice address
37390 N BRADUM RD, BAYFIELD, WI 54814-4832
(715) 779-3741
(715) 779-3765
Mailing address
88385 PIKE RD, BAYFIELD, WI 54814-4818
(715) 779-3741
(715) 779-3765
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
1781
WI
324500000X
Substance Abuse Rehabilitation Facility
1781
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42128500
—
WI
Enumeration date
11/05/2009
Last updated
11/05/2009
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