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General NPI Number Information
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NPI Number | 1609563170
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Entity Type | Organization
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Legal Business Name | AMERICAN INDIAN COUNCIL ON ALCOHOLISM, INC
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Dates
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Enumeration Date | 04/24/2023
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Last Update Date | 04/24/2023
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Provider Practice Location Address
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Address Line | 6510 W LAYTON AVE STE 101
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City | GREENFIELD
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State | WI
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Zip | 53220-4563
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Country | US
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Telephone | 414-930-9210
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Fax | 414-539-4388
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Provider Business Mailing Address
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Address Line | 6510 W LAYTON AVE STE 101
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City | GREENFIELD
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State | WI
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Zip | 53220-4563
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Country | US
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Telephone | 414-930-9210
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | RENEE LAFLEUR
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Credential | MS, EDS, CSAC
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Telephone | 414-930-9210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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