Provider Demographics
NPI:1093853798
Name:LASSEN COUNTY PUBLIC HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:LASSEN COUNTY PUBLIC HEALTH DEPARTMENT
Other - Org Name:LASSEN COUNTY PUBLIC HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OFLASSEN COUNTY H&SS
Authorized Official - Prefix:MS
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-251-8183
Mailing Address - Street 1:1445 PAUL BUNYAN RD
Mailing Address - Street 2:
Mailing Address - City:SUSANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96130-3142
Mailing Address - Country:US
Mailing Address - Phone:530-251-8183
Mailing Address - Fax:530-251-2668
Practice Address - Street 1:1445 BUNYAN RD
Practice Address - Street 2:
Practice Address - City:SUSANVILLE
Practice Address - State:CA
Practice Address - Zip Code:96130-3142
Practice Address - Country:US
Practice Address - Phone:530-251-8183
Practice Address - Fax:530-251-2668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA31140Medicare UPIN
CAFLV11127FMedicare ID - Type Unspecified