NPIMap

Organization Active NPI

Lakeland Village

  • Intellectual Disabilities Intermediate Care Facility
  • Medical Lake, WA
National Provider Identifier
1366594228
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
LAKELAND VILLAGE
Practice address
S 2320 Salnave Road
Medical Lake, WA 99022-0200
Phone
(509) 299-1001
Fax
(509) 299-1070
NPI assigned
Jan 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Kathryn A. Montague
Title
Superintendent
Phone
(509) 299-1001

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X Primary

Addresses

Primary practice location

S 2320 Salnave Road
Medical Lake, WA 99022-0200

Mailing address

PO Box 200
Medical Lake, WA 99022-0200
Phone (509) 299-1001

Other identifiers 1

IdentifierTypeStateIssuer
4012001MedicaidWA

National Provider Directory

National Provider Directory
Tax ID family
Lynden School District16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

Organizations that report the same tax identification number in the National Provider Directory.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1366594228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 200",
            "city": "MEDICAL LAKE",
            "state": "WA",
            "postal_code": "990220200",
            "telephone_number": "509-299-1001",
            "fax_number": "509-299-1070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "S 2320 SALNAVE ROAD",
            "city": "MEDICAL LAKE",
            "state": "WA",
            "postal_code": "990220200",
            "telephone_number": "509-299-1001",
            "fax_number": "509-299-1070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKELAND VILLAGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MONTAGUE",
        "authorized_official_first_name": "KATHRYN",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "SUPERINTENDENT",
        "authorized_official_telephone_number": "509-299-1001",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4012001",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Medical Lake, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.