Provider Demographics
NPI:1851411458
Name:LAKE COUNTY GOVERNMENT
Entity Type:Organization
Organization Name:LAKE COUNTY GOVERNMENT
Other - Org Name:LAKE COUNTY PUBLIC HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NIELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:719-486-2413
Mailing Address - Street 1:PO BOX 626
Mailing Address - Street 2:
Mailing Address - City:LEADVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80461-0626
Mailing Address - Country:US
Mailing Address - Phone:719-486-2413
Mailing Address - Fax:719-486-4168
Practice Address - Street 1:825 W 6TH ST
Practice Address - Street 2:
Practice Address - City:LEADVILLE
Practice Address - State:CO
Practice Address - Zip Code:80461-2205
Practice Address - Country:US
Practice Address - Phone:719-486-2413
Practice Address - Fax:719-486-4168
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAKE COUNTY GOVERNMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-29
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare