Lad Lake, Inc.

NPI #1114196854 in Dousman, Wisconsin

Provider Information

NPI Number: 1114196854
Entity Type: Organization
Organization Name: Lad Lake, Inc.
Primary Specialty: Residential Treatment Facility, Emotionally Disturbed Children
Enumeration Date: Feb 27, 2008
Last Updated: Feb 27, 2008

Practice Location

Address: W350S1401 WATERVILLE RD
City: Dousman
State: Wisconsin
ZIP Code: 53118-9020
Phone: (262) 965-2131

Authorized Official

Name: GARY L ERDMANN
Title: EXECUTIVE DIRECTOR
Phone: (262) 965-2131

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Community Based Residential Treatment Facility, Mental Illness	320800000X
Residential Treatment Facility, Emotionally Disturbed Children	322D00000X	Primary

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