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FOND DU LAC RESERVATION BUSINESS COMMITTEE NPI 1326053166


NPI Information

NPI: 1326053166
Provider Name: FOND DU LAC RESERVATION BUSINESS COMMITTEE

Doing Business As: FOND DU LAC HUMAN SERVICES DIVISION

Classification: Clinic/Center - 261Q00000X
Entity Type: Organization
Address:
927 TRETTLE LANE
FOND DU LAC HUMAN SERVICES DIVISION
CLOQUET, MN
ZIP 55720
Phone: (218) 879-1227
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FOND DU LAC RESERVATION BUSINESS COMMITTEE is a clinic center in Cloquet, MN. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). FOND DU LAC RESERVATION BUSINESS COMMITTEE NPI is 1326053166. The provider is registered as an organization entity type.
The provider Is Doing Business As Fond Du Lac Human Services Division.

The provider's business location address is:

927 TRETTLE LANE
FOND DU LAC HUMAN SERVICES DIVISION
CLOQUET, MN
ZIP 55720
Phone: (218) 879-1227
Fax: (218) 878-3800

The provider's authorized official is Marilyn Grover .
The authorized official title is Associate Director and has the following contact phone number (218) 879-1227.

The enumeration date for this NPI number is 7/30/2006 and was last updated on 2/2/2016.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1332B00000XDurable Medical Equipment & Medical Supplies5985000001MINNESOTANo
2261QR0405XClinic/CenterRehabilitation, Substance Use Disorder012003MINNESOTANo
3261Q00000XClinic/CenterMINNESOTAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1666815101MEDICAIDMINNESOTA
2C06351MEDICARE ID-TYPE UNSPECIFIEDMINNESOTA
38F27FOOTHERMINNESOTABCBS AODA
4666815100MEDICAIDMINNESOTA
55985000001MEDICARE NSCMINNESOTA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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