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General NPI Number Information
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NPI Number | 1922011667
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Entity Type | Organization
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Legal Business Name | COUNTY OF LAKE
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 08/22/2025
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Provider Practice Location Address
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Address Line | 3010 GRAND AVE
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City | WAUKEGAN
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State | IL
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Zip | 60085-2321
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Country | US
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Telephone | 847-377-8050
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Fax | 847-360-2938
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Provider Business Mailing Address
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Address Line | 3010 GRAND AVE
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City | WAUKEGAN
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State | IL
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Zip | 60085-2321
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Country | US
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Telephone | 847-377-8000
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Fax | 847-360-2938
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Authorized Official
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Title or Position | CFO
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Name | ANGELA COOPER
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Credential |
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Telephone | 847-377-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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