Provider Demographics
NPI:1922792340
Name:LAKE COUNTY GOVERNMENT/HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:LAKE COUNTY GOVERNMENT/HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNDICH
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:219-755-3658
Mailing Address - Street 1:2900 W 93RD AVENUE
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-1866
Mailing Address - Country:US
Mailing Address - Phone:219-755-3658
Mailing Address - Fax:219-755-3678
Practice Address - Street 1:2900 W 93RD AVENUE
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-1866
Practice Address - Country:US
Practice Address - Phone:219-755-3658
Practice Address - Fax:219-755-3678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Single Specialty