County of Lake

NPI #1619101292 in Waukegan, Illinois

Provider Information

NPI Number: 1619101292
Entity Type: Organization
Organization Name: County of Lake
Primary Specialty: Clinic/Center - Federally Qualified Health Center (FQHC)
Enumeration Date: May 11, 2009
Last Updated: Jun 18, 2010

Practice Location

Address: 2615 WASHINGTON STREET
City: Waukegan
State: Illinois
ZIP Code: 60085
Phone: (847) 377-8180

Authorized Official

Name: IRENE T PIERCE, MSN
Title: EXECUTIVE DIRECTOR
Phone: (847) 377-8000

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Federally Qualified Health Center (FQHC) — Federally Qualified Health Center (FQHC)	261QF0400X	Primary

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