Provider Demographics
NPI:1053587527
Name:LAKE COUNTY HUMAN SERVICES
Entity type:Organization
Organization Name:LAKE COUNTY HUMAN SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:HENKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-834-8415
Mailing Address - Street 1:616 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:TWO HARBORS
Mailing Address - State:MN
Mailing Address - Zip Code:55616-1518
Mailing Address - Country:US
Mailing Address - Phone:218-834-8401
Mailing Address - Fax:
Practice Address - Street 1:616 3RD AVE
Practice Address - Street 2:
Practice Address - City:TWO HARBORS
Practice Address - State:MN
Practice Address - Zip Code:55616-1518
Practice Address - Country:US
Practice Address - Phone:218-834-8401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAKE COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN662635100OtherMINNESOTA HEALTH CARE PROVIDER NUMBER