| 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 |