Provider Demographics
NPI:1669945713
Name:LAKE HEALTH DISTRICT
Entity type:Organization
Organization Name:LAKE HEALTH DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:DYBDAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-947-2114
Mailing Address - Street 1:700 S J ST
Mailing Address - Street 2:
Mailing Address - City:LAKEVIEW
Mailing Address - State:OR
Mailing Address - Zip Code:97630-1623
Mailing Address - Country:US
Mailing Address - Phone:541-947-2114
Mailing Address - Fax:541-947-2433
Practice Address - Street 1:100 N D ST STE 100
Practice Address - Street 2:
Practice Address - City:LAKEVIEW
Practice Address - State:OR
Practice Address - Zip Code:97630-1552
Practice Address - Country:US
Practice Address - Phone:541-947-2114
Practice Address - Fax:541-947-2433
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAKE HEALTH DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-10
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local