| Organization Name: | FOND DU LAC RESERVATION BUSINESS COMMITTEE |
| NPI Number: | 1326053166 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARILYN GROVER (ASSOCIATE DIRECTOR) |
| Mailing Address: | 927 Trettle Lane Fond Du Lac Human Services Division Cloquet |
| State: | MN US |
| Postal Code: | 55720 |
| Phone Number: | 2188791227 |
| Fax Number: | 2188783800 |
| NPI Enumeration Date: | 07/30/2006 |
| NPI Last Update Date: | 02/02/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | 5985000001 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MN |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |