Provider Demographics
NPI:1659583920
Name:COUNTY OF LAKE
Entity type:Organization
Organization Name:COUNTY OF LAKE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-377-8000
Mailing Address - Street 1:3010 GRAND AVE.
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085
Mailing Address - Country:US
Mailing Address - Phone:847-377-8180
Mailing Address - Fax:847-336-1517
Practice Address - Street 1:4118 GREENLEAF CT
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:IL
Practice Address - Zip Code:60085-8509
Practice Address - Country:US
Practice Address - Phone:847-377-8170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)