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General NPI Number Information
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NPI Number | 1699778233
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Entity Type | Organization
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Legal Business Name | THE LAKES COMMUNITY HEALTH CENTER, INC
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Dates
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Enumeration Date | 05/27/2005
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Last Update Date | 03/19/2019
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Provider Practice Location Address
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Address Line | 15397 STATE HIGHWAY 32
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City | LAKEWOOD
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State | WI
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Zip | 54138-9702
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Country | US
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Telephone | 715-276-6321
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Fax | 715-276-1428
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Provider Business Mailing Address
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Address Line | PO BOX 179
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City | LAKEWOOD
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State | WI
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Zip | 54138-0179
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Country | US
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Telephone | 715-276-6321
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Fax | 715-276-1428
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Authorized Official
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Title or Position | CEO
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Name | REBA RICE
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Credential |
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Telephone | 715-372-5001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number | 4757-800
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License Number State | WI
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