| Lake Grove Maple Valley | |
|
6 Farley Rd Wendell MA 01379-9706 | |
| (978) 544-6913 | |
| (978) 544-8672 |
| Full Name | Lake Grove Maple Valley |
|---|---|
| Speciality | Residential Treatment Facility, Emotionally Disturbed Children |
| Location | 6 Farley Rd, Wendell, Massachusetts |
| Authorized Official Name and Position | Felix Wienclaw (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 6316961400 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Grove Maple Valley Po Box 786 Medford NY 11763-0786 Ph: (631) 716-2127 | Lake Grove Maple Valley 6 Farley Rd Wendell MA 01379-9706 Ph: (978) 544-6913 |
| NPI Number | 1841468980 |
|---|---|
| Provider Enumeration Date | 02/12/2008 |
| Last Update Date | 02/12/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841468980 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | (* (Not Available)) | Primary |