| Organization Name: | FOREST COUNTY POTAWATOMI HEALTH & WELLNESS CENTER |
| NPI Number: | 1376650499 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAVID R BERTRAND (HEALTH CLINIC ADMINISTRATOR) |
| Mailing Address: | 8201 Mish Ko Swen Dr Crandon |
| State: | WI US |
| Postal Code: | 545208631 |
| Phone Number: | 7154784300 |
| Fax Number: | 7154784490 |
| NPI Enumeration Date: | 08/24/2006 |
| NPI Last Update Date: | 02/05/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |