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The Lakes Community Health Center, Inc

Organization Active NPI Federally Qualified Health Center (FQHC) · Park Falls, WI

NPI 1437619202 · NPPES record last updated Oct 12, 2023

Key facts

NPI
1437619202
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
THE LAKES COMMUNITY HEALTH CENTER, INC
Practice address
110 2ND Ave N
Park Falls, WI 54552-1214
Phone
(715) 762-2950
Fax
(715) 762-3561
NPI assigned
Mar 20, 2019
Organization subpart
No

Authorized official

Name
Rebecca Rice
Title
Ceo
Phone
(715) 372-5001

Other NPIs with the same Medicare PAC ID 12

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 19

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 107

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

View all 107

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
52D2157187Northlakes Community Clinic
110 2ND Ave N, Park Falls, WI 54552		Certificate of waiverOct 31, 2026

Medicare participation

Medicare fee-for-service enrollment
Enrolled in WI

Federally qualified health center certification: CCN 521030

Legal name
THE LAKES COMMUNITY HEALTH CENTER INC
Doing business as
NORTHLAKES COMMUNITY CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 4, 2023
Last certification
Oct 4, 2023
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Incorporated
May 14, 2007 in WI
Enrollment address
110 2ND Ave N
Park Falls, WI 54552-1214

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Rebecca S Rice
Individual 		Corporate Officer
Ceo		 Aug 19, 2010
W-2 Managing Employee
Ceo		 Mar 5, 2009
Frank G Suo
Individual 		Corporate Director
Board of Directors President		 Jan 1, 2022

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20231012000161 WI Part a Provider - Federally Qualified Health Center (FQHC) 0840366654 Practice locations: Park Falls, WI

National Provider Directory

Tax ID family
The Lakes Community Health Center Inc (20 organizations share this tax ID)

Locations

110 2nd Ave N
Park Falls, WI 54552
Phone (715) 762-2950

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Yes

Addresses

Primary practice location

110 2ND Ave N
Park Falls, WI 54552-1214

Mailing address

15735 W US Highway 63
Hayward, WI 54843-6475
Phone (715) 934-0710

Other identifiers

IdentifierTypeStateIssuer
1811178825MedicaidWI

Other names

  • NorthLakes Community Clinic Doing business as

Other providers in Park Falls, WI

All providers in Park Falls, WI · Federally Qualified Health Center (FQHC) in Wisconsin

Sources for this page

Verify at the official NPI Registry.