Fond Du Lac Reservation Business Committee

LBN: Fdl Adolescent Outpatient Tx
Fond Du Lac Reservation Business Committee is an health care organization with primary practice located at 927 Trettel Ln , Cloquet MN 55720-1345. The organization recently has only one registered license in Ambulatory Health Care Facilities / Adolescent and Children Mental Health, which is considered as the primary health care specialty. Fdl Adolescent Outpatient Tx can be contacted via phone (218) 879-1227, or through Grover, Marilyn via phone (218) 879-1227.

Contact Information

Primary practice address
927 Trettel Ln Cloquet MN 55720-1345
Phone: (218) 879-1227
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Grover, Marilyn
Phone: (218) 879-1227

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Adolescent and Children Mental Health 261QM0855X

Profile Details

NPI number 1447606959
LBN Legal business name Fdl Adolescent Outpatient Tx
DBA Doing business as Fond Du Lac Reservation Business Committee
Authorized official Grover, Marilyn
Entity Organization
Organization subpart 1 Yes
Enumeration date May 13th, 2016
Last updated Oct 10th, 2016 - about 9 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1447606959 NPPES
Minnesota MEDICAID 666815101
Minnesota MEDICAID 666815100
Minnesota Other 8F27F0

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