Lad Lake, Inc.
Organization Active NPI Emotionally Disturbed Childrens' Residential Treatment Facility · Dousman, WI
NPI 1114196854 · NPPES record last updated Feb 27, 2008
Key facts
- NPI
- 1114196854
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X
- License
- 265001 (WI)
- Legal business name
- LAD LAKE, INC.
- Practice address
- W350S1401 Waterville Rd
Dousman, WI 53118-9020 - Phone
- (262) 965-2131
- NPI assigned
- Feb 27, 2008
- Organization subpart
- No
Authorized official
- Name
- Gary L Erdmann
- Title
- Executive Director
- Phone
- (262) 965-2131
Practitioners 7
-
Mary Bachman, RN
-
Dennis James Neuenfeldt, LCSW, LMFT
-
Edward Michael Smith, LPC-IT
-
George Vohwinkle, LCSW
National Provider Directory
Locations
W350S1401 Waterville Rd
Dousman, WI 53118
Phone (262) 965-2131
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Illness Community Based Residential Treatment Facility | 320800000X | NONE | WI | |
| Emotionally Disturbed Childrens' Residential Treatment Facility | 322D00000X | 265001 | WI | Yes |
Addresses
Primary practice location
W350S1401 Waterville Rd
Dousman, WI 53118-9020
Mailing address
W350S1401 Waterville Rd
Dousman, WI 53118-9020
Phone (262) 965-2131
Other providers in Dousman, WI
- Joel Thomas Kennedy
- Jamie Kernen
- Joann Krofta
- Richard Labinski
- Erika Lacombe
- Sarah Nicole Lind
- Zachary Lovdahl
- Debra Makinen
- Judy Rene Martinez
- Masonic Center for Health and Rehab Inc.
All providers in Dousman, WI · Emotionally Disturbed Childrens' Residential Treatment Facility in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 27, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.