| NPI | 1346620952 |
|---|---|
| Doing Business As | CMS FOND DU LAC |
| Entity Type | Organization |
| Authorized Contact | CINDY GAITHER VP Revenue Cycle Mgmt 602-248-8886 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 251S00000X (Licence: WI 3075) | |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2024-02-10 |