Provider Demographics
NPI:1043626443
Name:LAKE COUNTY JAIL
Entity Type:Organization
Organization Name:LAKE COUNTY JAIL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:WALLACE
Authorized Official - Last Name:FORGEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-755-3385
Mailing Address - Street 1:2293 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-1854
Mailing Address - Country:US
Mailing Address - Phone:219-648-6300
Mailing Address - Fax:219-755-3427
Practice Address - Street 1:2293 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-1854
Practice Address - Country:US
Practice Address - Phone:219-648-6300
Practice Address - Fax:219-755-3427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare