Lac Du Flambeau Band of Lake Superior Chippewa Indians

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

LAC DU FLAMBEAU BAND OF LAKE SUPERIOR CHIPPEWA INDIANS

Practice address

3378 N. Schilleman Rd
Lac Du Flambeau, WI 54538-0815

Phone

(715) 388-0762

Fax

(715) 588-1889

NPI assigned

Jan 24, 2018

Organization subpart

No

Name

Pamela Ahlborn

Title

Compliance & Contract Coordinator

Phone

(715) 588-4422

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

• Sheli Faust, PC, SAC-IT

  • Professional Counselor
  • Lac Du Flambeau, WI
  • NPI 1548619828
  NPD (past)

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

CLIA laboratory certificates

• Gookomis Endaad Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 13, 2018.

{
    "created_epoch": "1516752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1536796800000",
    "number": "1669970729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 815",
            "city": "LAC DU FLAMBEAU",
            "state": "WI",
            "postal_code": "545380815",
            "telephone_number": "715-588-4422",
            "fax_number": "715-588-1889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3378 N. SCHILLEMAN RD",
            "city": "LAC DU FLAMBEAU",
            "state": "WI",
            "postal_code": "545380815",
            "telephone_number": "715-388-0762",
            "fax_number": "715-588-1889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAC DU FLAMBEAU BAND OF LAKE SUPERIOR CHIPPEWA INDIANS",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-24",
        "last_updated": "2018-09-13",
        "status": "A",
        "authorized_official_last_name": "AHLBORN",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_title_or_position": "COMPLIANCE & CONTRACT COORDINATOR",
        "authorized_official_telephone_number": "715-588-4422"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "WI",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "WI",
            "license": "3100",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gookomis Endaad",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Gookomis Endaad",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Scott C Kuehn, CSAC
• Lac Du Flambeau Band of Lake Superior Chippewa Indians
• Lac Du Flambeau Band of Lake Superior Chippewa Indians
• Lac Du Flambeau Band of Lake Superior Chippewa Indians
• Lac Du Flambeau Band of Lake Superior Chippewa Indians
• Lac Du Flambeau Band of Lake Superior Chippewa Indians
• Lac Du Flambeau Public Schools
• Karen Sue Lamp, LDH
• Nicholis Ross Laporte, PHARMD
• Tieheena M Lemerond, SAC-IT

• All providers in Lac Du Flambeau, WI
• Mental Health Clinic/Center (Including Community Mental Health Center) in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.