| Organization Name: | FOND DU LAC RESERVATION BUSINESS COMMITTEE |
| NPI Number: | 1225335862 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARILYN GROVER (ASSOCIATE DIRECTOR) |
| Mailing Address: | 61 Marigold Lane Tagwii Cloquet |
| State: | MN US |
| Postal Code: | 55720 |
| Phone Number: | 2188791227 |
| Fax Number: | 2188783755 |
| NPI Enumeration Date: | 02/17/2011 |
| NPI Last Update Date: | 04/26/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0405X |
| License Number: | 012010 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rehabilitation, Substance Use Disorder |
| Taxonomy Definition: | |