Organization
THE LAKE GROVE SCHOOL
Active
Parent organization
WINDWOOD MEADOW, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
WINDWOOD MEADOW, INC.
Authorized official
MR. FELIX WIENCLAW (CHIEF FINANCIAL OFFICER)
(631) 696-1400
Entity
Organization
Contact information
Practice address
3390 ROUTE 112, MEDFORD, NY 11763-1421
(631) 696-1400
(631) 716-2135
Mailing address
PO BOX 786, MEDFORD, NY 11763-0786
(631) 969-1400
(631) 716-2135
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00892773
—
NY
Enumeration date
05/07/2008
Last updated
05/07/2008
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