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NPI Code Detail

MEDICARE: FOREST COUNTY POTAWATOMI HEALTH & WELLNESS CENTER

MEDICARE: FOREST COUNTY POTAWATOMI HEALTH & WELLNESS CENTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor
2261QM0850XAdult Mental Health Clinic/Center
3261QM0855XAdolescent and Children Mental Health Clinic/Center
4261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1376650499
Entity Type Code : Organization
Provider Name (Legal Business Name) : FOREST COUNTY POTAWATOMI HEALTH & WELLNESS CENTER
Provider Business Mailing Address
First Line : PO BOX 396
Second Line : 8201 MISH KO SWEN DRIVE
City : CRANDON
State : WI
Zip : 54520-0396
Country : US
Telephone Number : 715-478-4300
Fax Number : 715-478-4490
Provider Business Practice Location Address
First Line : 8201 MISH KO SWEN DR
Second Line :
City : CRANDON
State : WI
Zip : 54520-8631
Country : US
Telephone Number : 715-478-4300
Fax Number : 715-478-4490
Authorized Official
Title or Position : TRIBAL CHAIRMAN
Name : MR. NED DANIELS
Credential :
Telephone Number : 715-478-4824
Provider Enumeration Date : 08/24/2006
Last Update Date : 12/09/2020

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Directions to “FOREST COUNTY POTAWATOMI HEALTH & WELLNESS CENTER ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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