Healthcare Provider Details

I. General information

NPI: 1407911795
Provider Name (Legal Business Name): HO-CHUNK NATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N6520 LUMBERJACK GUY RD
BLACK RIVER FALLS WI
54615-5405
US

IV. Provider business mailing address

N6520 LUMBERJACK GUY RD
BLACK RIVER FALLS WI
54615-5405
US

V. Phone/Fax

Practice location:
  • Phone: 715-284-9851
  • Fax: 715-284-5150
Mailing address:
  • Phone: 715-284-9851
  • Fax: 715-284-5150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number1413
License Number StateWI

VIII. Authorized Official

Name: LIZ MARIE LUND
Title or Position: PROVIDER NETWORK MANAGER
Credential:
Phone: 715-284-9851