Provider Demographics
NPI:1447743703
Name:COUNTY OF LANDER
Entity Type:Organization
Organization Name:COUNTY OF LANDER
Other - Org Name:LANDER COUNTY COMMUNITY HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:DEONILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-635-2386
Mailing Address - Street 1:825 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BATTLE MOUNTAIN
Mailing Address - State:NV
Mailing Address - Zip Code:89820-2834
Mailing Address - Country:US
Mailing Address - Phone:775-635-2386
Mailing Address - Fax:
Practice Address - Street 1:825 N 2ND ST
Practice Address - Street 2:
Practice Address - City:BATTLE MOUNTAIN
Practice Address - State:NV
Practice Address - Zip Code:89820-2834
Practice Address - Country:US
Practice Address - Phone:775-635-2386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF LANDER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-12
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1700174802Medicaid