Provider Demographics
NPI:1053492108
Name:LAKEVIEW DISASTER UNIT, INC.
Entity Type:Organization
Organization Name:LAKEVIEW DISASTER UNIT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-947-4872
Mailing Address - Street 1:245 N F ST
Mailing Address - Street 2:
Mailing Address - City:LAKEVIEW
Mailing Address - State:OR
Mailing Address - Zip Code:97630-1409
Mailing Address - Country:US
Mailing Address - Phone:541-947-2504
Mailing Address - Fax:
Practice Address - Street 1:245 N F ST
Practice Address - Street 2:
Practice Address - City:LAKEVIEW
Practice Address - State:OR
Practice Address - Zip Code:97630-1409
Practice Address - Country:US
Practice Address - Phone:541-947-2504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR111278Medicaid