# IRONWOOD LAKE HOUSE

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Parent organization:** IRONWOOD MAINE
- **Other names:** Ironwood lake House
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1821872797
- **Legal business name:** IRONWOOD MAINE
- **Authorized official:** DEBORA GARCIA (RCM MANAGER)
- **Authorized official phone:** (310) 457-6302

## Contact information

- **Practice address:** 24 POND HILL RD, SOUTH CHINA, ME 04358-5009
- **Practice address phone:** (310) 457-6302
- **Practice address fax:** (310) 457-6318
- **Mailing address:** 12424 WILSHIRE BLVD STE 800, LOS ANGELES, CA 90025-1035
- **Mailing address phone:** (310) 457-6302
- **Mailing address fax:** (310) 457-6318

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 323P00000X | Psychiatric Residential Treatment Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 08/22/2023
- **Last updated:** 08/22/2023