Organization
LAKELAND VILLAGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KATHRYN A. MONTAGUE (SUPERINTENDENT)
(509) 299-1001
Entity
Organization
Contact information
Practice address
S 2320 SALNAVE ROAD, MEDICAL LAKE, WA 99022-0200
(509) 299-1001
(509) 299-1070
Mailing address
PO BOX 200, MEDICAL LAKE, WA 99022-0200
(509) 299-1001
(509) 299-1070
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4012001
—
WA
Enumeration date
01/18/2007
Last updated
08/22/2020
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