| Organization Name: | COUNTY OF LAKE |
| NPI Number: | 1750310884 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | IRENE T PIERCE (EXECUTIVE DIRECTOR) |
| Mailing Address: | 224 W Clarendon Dr Round Lake Beach |
| State: | IL US |
| Postal Code: | 600731896 |
| Phone Number: | 8479845100 |
| Fax Number: | 8479845120 |
| NPI Enumeration Date: | 07/01/2006 |
| NPI Last Update Date: | 01/22/2009 |
| 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: | |