Healthcare Provider Details

I. General information

NPI: 1497766570
Provider Name (Legal Business Name): COUNTY OF LAKE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 12/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 GRAND AVE
WAUKEGAN IL
60085-2321
US

IV. Provider business mailing address

3010 GRAND AVE
WAUKEGAN IL
60085-2321
US

V. Phone/Fax

Practice location:
  • Phone: 847-377-8000
  • Fax: 847-360-2938
Mailing address:
  • Phone: 847-377-8000
  • Fax: 847-360-2938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. IRENE T PIERCE
Title or Position: EXECUTIVE DIRECTOR
Credential: MSN
Phone: 847-377-8000