1750310884 NPI number — COUNTY OF LAKE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750310884 NPI number — COUNTY OF LAKE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF LAKE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LAKE COUNTY HEALTH DEPARTMENT AND COMMUNITY HEALTH CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750310884
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3010 GRAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAUKEGAN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60085-2321
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-377-8000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
224 W CLARENDON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROUND LAKE BEACH
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60073-1896
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-984-5100
Provider Business Practice Location Address Fax Number:
847-984-5120
Provider Enumeration Date:
07/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PIERCE
Authorized Official First Name:
IRENE
Authorized Official Middle Name:
T
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
847-377-8000

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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