Healthcare Provider Details

I. General information

NPI: 1144298787
Provider Name (Legal Business Name): THE LAKES COMMUNITY HEALTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 08/05/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11128 N STATE ROAD 77
HAYWARD WI
54843-5332
US

IV. Provider business mailing address

15735 W US HIGHWAY 63
HAYWARD WI
54843-6475
US

V. Phone/Fax

Practice location:
  • Phone: 715-634-2541
  • Fax: 715-634-5740
Mailing address:
  • Phone: 715-934-0710
  • Fax: 715-598-4881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: REBA RICE
Title or Position: CEO
Credential:
Phone: 715-372-5001