National Provider Identifier Database

MENOMINEE INDIAN TRIBE OF WISCONSIN
Mental Health (Including Community Mental Health Center)


Contact Information

MENOMINEE INDIAN TRIBE OF WISCONSIN
W3275 WOLF RIVER ROAD
KESHENA, WI54135
Phone: 715-799-3361
Fax: 715-799-3099
Website:
Specialty Taxonomy Code
* Mental Health (Including Community Mental Health Center) 261QM0801X

* Indicates primary specialty

NPI Profile & details for MENOMINEE INDIAN TRIBE OF WISCONSIN

NPI Number 1124291802
Legal business name
LBN
MENOMINEE INDIAN TRIBE OF WISCONSIN
Authorized official JERRY WAUKAU - (HEALTH ADMINISTRATOR)
Entity Organization
Organization subpart No
Enumeration date 04/02/2008
Last updated 04/02/2008 - About 18 years ago
Sole proprietor1 Not specified
Identifiers
  • WI License #: 1588
  • WI Medicaid: 42173700

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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