The Lake Grove School

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

Legal business name

THE LAKE GROVE SCHOOL

Practice address

3390 Route 112
Medford, NY 11763-1421

Phone

(631) 696-1400

Fax

(631) 716-2135

NPI assigned

May 7, 2008

Organization subpart

Yes

Parent organization

WINDWOOD MEADOW, INC.As reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Felix Wienclaw

Title

Chief Financial Officer

Phone

(631) 696-1400

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1210118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210118400000",
    "number": "1093981235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 786",
            "city": "MEDFORD",
            "state": "NY",
            "postal_code": "117630786",
            "telephone_number": "631-969-1400",
            "fax_number": "631-716-2135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3390 ROUTE 112",
            "city": "MEDFORD",
            "state": "NY",
            "postal_code": "117631421",
            "telephone_number": "631-696-1400",
            "fax_number": "631-716-2135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE LAKE GROVE SCHOOL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WINDWOOD MEADOW, INC.",
        "enumeration_date": "2008-05-07",
        "last_updated": "2008-05-07",
        "status": "A",
        "authorized_official_last_name": "WIENCLAW",
        "authorized_official_first_name": "FELIX",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "631-696-1400",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00892773",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Emotionally Disturbed Childrens' Residential Treatment Facility in Medford, NY
• Providers in Medford, NY by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.