| Organization Name: | THE LAKES COMMUNITY HEALTH CENTER INC |
| NPI Number: | 1083961163 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BRIAN D AHLGREN (CFO) |
| Mailing Address: | 600 W Shell Creek Rd Minong |
| State: | WI US |
| Postal Code: | 548599302 |
| Phone Number: | 7154662201 |
| Fax Number: | 7154662205 |
| NPI Enumeration Date: | 08/08/2012 |
| NPI Last Update Date: | 09/11/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QF0400X |
| License Number: | 26972 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
| Taxonomy Definition: | |