RED CLIFF AODA PROGRAM/MISHOMIS HOUSE NPI 1457688863

NPI Information

  • NPI: 1457688863
  • Provider Name: RED CLIFF AODA PROGRAM/MISHOMIS HOUSE
  • Classification: Clinic/Center - 261QR0405X
  • Specialization: Rehabilitation, Substance Use Disorder
  • Entity Type: Organization
  • CLIA Number: 52D0855724
  • Address: 37390 N BRADUM RD
    BAYFIELD, WI
    ZIP 54814
  • Phone: (715) 779-3741

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NPI Details

RED CLIFF AODA PROGRAM/MISHOMIS HOUSE is a rehabilitation and substance use disorder clinic center in Bayfield, WI. RED CLIFF AODA PROGRAM/MISHOMIS HOUSE NPI is 1457688863. The provider is registered as an organization entity type.

The provider's business location address is:

37390 N BRADUM RD
BAYFIELD, WI
ZIP 54814-832
Phone: (715) 779-3741
Fax: (715) 779-3765

The provider's authorized official is Martin A Gordon .
The authorized official title is Program Director and has the following contact phone number (715) 779-3741.

The CLIA number assigned to this NPI record is 52D0855724 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 11/5/2009 and was last updated on 11/5/2009.

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
1324500000XSubstance Abuse Rehabilitation Facility1781WISCONSINNo
2261QR0405XClinic/CenterRehabilitation, Substance Use Disorder1781WISCONSINYes

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
142128500MEDICAIDWISCONSIN

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: 3/30/2025

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