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General NPI Number Information
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NPI Number | 1376698522
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Entity Type | Organization
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Legal Business Name | LAKE HEALTH DISTRICT
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 700 S J ST
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City | LAKEVIEW
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State | OR
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Zip | 97630-1623
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Country | US
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Telephone | 541-947-2114
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Fax | 541-947-2433
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Provider Business Mailing Address
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Address Line | 700 S J ST
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City | LAKEVIEW
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State | OR
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Zip | 97630-1623
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Country | US
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Telephone | 541-947-2114
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Fax | 541-947-2433
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Authorized Official
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Title or Position | CEO
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Name | LANDON DYBDAL
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Credential |
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Telephone | 541-947-2114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC0050X
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Taxonomy Name | Critical Access Hospital Clinic/Center
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License Number | 140896
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 1836773096
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | 140896
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License Number State | OR
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