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General NPI Number Information
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NPI Number | 1215453659
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Entity Type | Organization
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Legal Business Name | LAC COURTE OREILLES COMPREHENSIVE CARE SERVICES
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Dates
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Enumeration Date | 08/17/2017
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 9940 N COUNTY HWY K
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City | HAYWARD
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State | WI
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Zip | 54843-2186
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Country | US
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Telephone | 715-638-5169
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Fax |
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Provider Business Mailing Address
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Address Line | 930 W HISTORIC MITCHELL ST
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City | MILWAUKEE
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State | WI
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Zip | 53204-3533
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Country | US
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Telephone | 414-383-9526
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Fax | 414-649-2711
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | RAE E BAKER
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Credential |
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Telephone | 715-638-5169
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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