Organization
LAKE GROVE MAPLE VALLEY
Active
Parent organization
WINDWOOD MEADOW
Organization subpart
Yes
Provider details
NPI number
Legal business name
WINDWOOD MEADOW
Authorized official
MR. FELIX WIENCLAW (CHIEF FINANCIAL OFFICER)
(631) 696-1400
Entity
Organization
Contact information
Practice address
6 FARLEY RD, WENDELL, MA 01379-9706
(978) 544-6913
(978) 544-8672
Mailing address
PO BOX 786, MEDFORD, NY 11763-0786
(631) 716-2127
(631) 716-2135
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Enumeration date
02/12/2008
Last updated
02/12/2008
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