| Organization Name: | LAC DU FLAMBEAU BAND OF LAKE SUPERIOR CHIPPEWA INDIANS |
| NPI Number: | 1427347426 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JEANNE M WOLFE (COMPLIANCE OFFICER) |
| Mailing Address: | 128 Old Abe Rd Lac Du Flambeau |
| State: | WI US |
| Postal Code: | 545389682 |
| Phone Number: | 7155884466 |
| Fax Number: | 7155882269 |
| NPI Enumeration Date: | 03/31/2011 |
| NPI Last Update Date: | 01/28/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QF0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
| Taxonomy Definition: | |