# LAKE GROVE MAPLE VALLEY

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** WINDWOOD MEADOW
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1841468980
- **Legal business name:** WINDWOOD MEADOW
- **Authorized official:** MR. FELIX WIENCLAW (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (631) 696-1400

## Contact information

- **Practice address:** 6 FARLEY RD, WENDELL, MA 01379-9706
- **Practice address phone:** (978) 544-6913
- **Practice address fax:** (978) 544-8672
- **Mailing address:** PO BOX 786, MEDFORD, NY 11763-0786
- **Mailing address phone:** (631) 716-2127
- **Mailing address fax:** (631) 716-2135

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251S00000X | Community/Behavioral Health Agency | — | NULL | — |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 02/12/2008
- **Last updated:** 02/12/2008