The Lake Grove School

NPI #1093981235 in Medford, New York

Provider Information

NPI Number: 1093981235
Entity Type: Organization
Organization Name: The Lake Grove School
Subpart: Yes (part of a larger organization)
Parent Organization: WINDWOOD MEADOW, INC.
Primary Specialty: Residential Treatment Facility, Emotionally Disturbed Children
Enumeration Date: May 7, 2008
Last Updated: May 7, 2008

Practice Location

Address: 3390 ROUTE 112
City: Medford
State: New York
ZIP Code: 11763-1421
Phone: (631) 696-1400

Authorized Official

Name: MR. FELIX WIENCLAW
Title: CHIEF FINANCIAL OFFICER
Phone: (631) 696-1400

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Residential Treatment Facility, Emotionally Disturbed Children	322D00000X	Primary

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