RED CLIFF AODA PROGRAM/MISHOMIS HOUSE (NPI# 1457688863) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457688863 |
| Entity Type | Organization |
| Organization Name | RED CLIFF AODA PROGRAM/MISHOMIS HOUSE |
| Practice Address |
37390 N Bradum Rd Bayfield WI 54814-4832 |
| Mailing Address |
88385 Pike Rd Bayfield WI 54814-4818 |
| Practice Telephone | 7157793741 |
| Practice Fax Number | 7157793765 |
| Mailing Telephone | 7157793741 |
| Mailing Fax Number | 7157793765 |
| Enumeration Date | 2009-11-05 |
| Last Update Date | 2009-11-05 |
| Authorized Official Name | MARTIN A GORDON (PROGRAM DIRECTOR) |
| Authorized Official Telephone | 7157793741 |
| Authorized Official Credential | CSAC/ICS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 324500000X | Substance Abuse Rehabilitation Facility | 1781 | WI | Residential Treatment Facilities |
| Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
1781 | WI | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 42128500 | 05 |
| Street Address |
37390 N BRADUM RD |
| City | BAYFIELD |
| State | WI |
| Zip Code | 54814-4832 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326133323 | Martin A Gordon | Counselor | 37390 N Bradum Rd, Bayfield, WI 54814-4832 | 2006-10-04 |
| 1487079521 | Gail Marie Lemieux | Counselor | 37390 N Bradum Rd, Bayfield, WI 54814-4832 | 2014-02-26 |
| 1598060857 | Christopher Daniel Boyd Sr. | Counselor | 37390 N Bradum Rd, Bayfield, WI 54814-4832 | 2011-01-18 |
| 1023167954 | Red Cliff Band of Chippewa Indians | Counselor | 37390 N Bradum Rd, Bayfield, WI 54814-4832 | 2007-01-09 |
| 1003906009 | Patricia M. Kenote-deperry | Counselor | 37390 N Bradum Rd, Bayfield, WI 54814-4832 | 2006-10-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760830103 | Orthopedic & Spine Therapy of Poplar Sc | Physical Therapist | 33 N 1st St, Bayfield, WI 54814 | 2016-05-26 |
| 1265812481 | Valley Birch, LLC | Community/Behavioral Health | 249 Rittenhouse Avenue, Bayfield, WI 54814 | 2015-06-03 |
| 1205007796 | Red Cliff Band of Lake Superior Chippewa | Social Worker | 88455 Pike Road, Bayfield, WI 54814 | 2008-03-12 |
| 1518137652 | Ellie Heydari | Dentist | 36745 Aiken Rd., Red Cliff Community Health Center, Bayfield, WI 54814 | 2008-03-05 |
| 1174672844 | Red Cliff Band of Lake Superior Chippewa Indians | Ambulance | 37435 Sth 13, Bayfield, WI 54814 | 2007-01-10 |
| 1730257122 | Red Cliff Band of Lake Superior Chippewa | Pharmacist | 88385 Pike Road, Bayfield, WI 54814 | 2006-12-01 |
| 1568484764 | Janice K Wilber | Pharmacist | 88455 Pike Road, Highway 13, Bayfield, WI 54814 | 2006-07-24 |
| 1902077464 | Red Cliff Band of Lake Superior Chippewa | Registered Nurse | 88455 Pike Road, Bayfield, WI 54814 | 2008-03-12 |
| 1083885545 | Red Cliff Band of Lake Superior Chippewa | Durable Medical Equipment & Medical Supplies | 88455 Pike Road, Bayfield, WI 54814 | 2008-03-12 |
| 1730102203 | Barbara M Tellier | Pharmacist | 88455 Pike Road, Highway 13, Bayfield, WI 54814 | 2006-07-25 |
| Find all providers in zip 54814 | ||||
| Taxonomy Code | 261QR0405X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Substance Use Disorder |
| Definition to come... |
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| 1245628817 | Forever Free Substance Abuse and Mental Heath Treament Center | Clinic/Center | 724 S Layton Blvd, Milwaukee, WI 53215-1224 | 2015-01-05 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.