Provider Demographics
NPI:1235464496
Name:LAKE COUNTY COMMUNITY ACTION AGENCY
Entity Type:Organization
Organization Name:LAKE COUNTY COMMUNITY ACTION AGENCY
Other - Org Name:NEW BEGINNINGS HIGHLANDS HIGH SCHOOL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GEORGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEHNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-995-2920
Mailing Address - Street 1:15312 LAKESHORE DRIVE
Mailing Address - Street 2:PO BOX 969
Mailing Address - City:CLEARLAKE
Mailing Address - State:CA
Mailing Address - Zip Code:95422
Mailing Address - Country:US
Mailing Address - Phone:707-995-2920
Mailing Address - Fax:
Practice Address - Street 1:15850 A DAM ROAD
Practice Address - Street 2:
Practice Address - City:CLEARLAKE
Practice Address - State:CA
Practice Address - Zip Code:95422
Practice Address - Country:US
Practice Address - Phone:707-994-6447
Practice Address - Fax:707-994-1875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-06
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA170010BN251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA014651850OtherCOMMUNITY BEHAVIORAL HEALTH