| Organization Name: | LAKE COUNTY TRIBAL HEALTH CONSORTIUM, INC. |
| NPI Number: | 1215327804 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ERNESTO PADILLA (EXECUTIVE DIRECTOR) |
| Mailing Address: | 359 Lakeport Blvd Lakeport |
| State: | CA US |
| Postal Code: | 954535412 |
| Phone Number: | 7075332700 |
| Fax Number: | 7072635400 |
| NPI Enumeration Date: | 02/03/2015 |
| NPI Last Update Date: | 02/03/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QC1500X |
| License Number: | 110000289 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Community Health |
| Taxonomy Definition: | |