Provider Demographics
NPI:1164686028
Name:LAKE COUNTY BOARD OF COUNTY COMMISSIONERS
Entity Type:Organization
Organization Name:LAKE COUNTY BOARD OF COUNTY COMMISSIONERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMMISSIONER/CHAIRMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:WELTON
Authorized Official - Middle Name:G
Authorized Official - Last Name:CADWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-343-9850
Mailing Address - Street 1:PO BOX 7800
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-7800
Mailing Address - Country:US
Mailing Address - Phone:352-343-9850
Mailing Address - Fax:352-343-9495
Practice Address - Street 1:315 W MAIN ST
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-3813
Practice Address - Country:US
Practice Address - Phone:352-343-9850
Practice Address - Fax:352-343-9495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health