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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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