Organization
LAD LAKE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY L ERDMANN (EXECUTIVE DIRECTOR)
(262) 965-2131
Entity
Organization
Contact information
Practice address
W350S1401 WATERVILLE RD, DOUSMAN, WI 53118-9020
(262) 965-2131
Mailing address
W350S1401 WATERVILLE RD, DOUSMAN, WI 53118-9020
(262) 965-2131
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
NONE
WI
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
265001
WI
Other
Enumeration date
02/27/2008
Last updated
02/27/2008
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