NPI 1093981235

The Lake Grove School

Organisation Emotionally Disturbed Childrens' Residential Treatment Facility Medford, NY

Practice location

Address: 3390 Route 112, Medford, NY 11763-1421
Phone: (631) 696-1400
Fax: (631) 716-2135
Mailing address: PO Box 786, Medford, NY 11763-0786

Authorised official

Name: Felix Wienclaw
Title: Chief Financial Officer
Phone: (631) 696-1400

Registered specialties

Emotionally Disturbed Childrens' Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 322D00000X

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Registry record

NPI: 1093981235
Entity type: Organization
NPI issued: 7 May 2008
Record last updated: 7 May 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.