| Organization Name: | COUNTY OF LAKE |
| NPI Number: | 1639588254 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ANTONIO BELTRAN (EXECUTIVE DIRECTOR) |
| Mailing Address: | 800 High School Dr Round Lake |
| State: | IL US |
| Postal Code: | 600732951 |
| Phone Number: | 8473778531 |
| Fax Number: | |
| NPI Enumeration Date: | 08/07/2014 |
| NPI Last Update Date: | 09/09/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QF0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
| Taxonomy Definition: | |