NPIMap

Organization Active NPI

Fond Du Lac Reservation Business Committee

  • Clinic/Center
  • Cloquet, MN
National Provider Identifier
1326053166
Registry record updated Feb 2, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
FOND DU LAC RESERVATION BUSINESS COMMITTEE
Practice address
927 Trettle Lane
Fond Du Lac Human Services Division
Cloquet, MN 55720
Phone
(218) 879-1227
Fax
(218) 878-3800
NPI assigned
Jul 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Marilyn Grover
Title
Associate Director
Phone
(218) 879-1227

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X MN Primary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 012003 MN
Durable Medical Equipment & Medical Supplies 332B00000X 5985000001 MN

Addresses

Primary practice location

927 Trettle Lane
Fond Du Lac Human Services Division
Cloquet, MN 55720

Mailing address

927 Trettle Lane
Fond Du Lac Human Services Division
Cloquet, MN 55720
Phone (218) 879-1227

Other identifiers 3

IdentifierTypeStateIssuer
666815100MedicaidMN
666815101MedicaidMN
8F27FOOtherMNBCBS AODA

Other names 1

  • Fond du Lac Human Services Division Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040107000308 MN Part B Supplier - Clinic/Group Practice 6608775879 Receives reassigned benefits from 70 practitioners
1 other NPI on this enrollment
Practice locations: Cloquet, MN; Duluth, MN

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 73

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 73

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454371200000",
    "number": "1326053166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "927 TRETTLE LANE",
            "address_2": "FOND DU LAC HUMAN SERVICES DIVISION",
            "city": "CLOQUET",
            "state": "MN",
            "postal_code": "55720",
            "telephone_number": "218-879-1227",
            "fax_number": "218-878-3800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "927 TRETTLE LANE",
            "address_2": "FOND DU LAC HUMAN SERVICES DIVISION",
            "city": "CLOQUET",
            "state": "MN",
            "postal_code": "55720",
            "telephone_number": "218-879-1227",
            "fax_number": "218-878-3800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOND DU LAC RESERVATION BUSINESS COMMITTEE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-30",
        "last_updated": "2016-02-02",
        "status": "A",
        "authorized_official_last_name": "GROVER",
        "authorized_official_first_name": "MARILYN",
        "authorized_official_title_or_position": "ASSOCIATE DIRECTOR",
        "authorized_official_telephone_number": "218-879-1227",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "MN",
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "MN",
            "license": "012003",
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MN",
            "license": "5985000001",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "666815100",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "666815101",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS AODA",
            "identifier": "8F27FO",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fond du Lac Human Services Division",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cloquet, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.