Healthcare Provider Details

I. General information

NPI: 1285062489
Provider Name (Legal Business Name): LAKE HEALTH DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2013
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 S MAIN ST
ALTURAS CA
96101-4114
US

IV. Provider business mailing address

700 SOUTH J ST
LAKEVIEW OR
97630-1623
US

V. Phone/Fax

Practice location:
  • Phone: 530-233-2288
  • Fax: 530-223-1941
Mailing address:
  • Phone: 541-947-2114
  • Fax: 541-947-8116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0000001616
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHARLES BODELL TVEIT
Title or Position: CEO
Credential:
Phone: 541-947-7307