NPIMap

Organization Active NPI

Ironwood Lake House

  • Psychiatric Residential Treatment Facility
  • South China, ME
National Provider Identifier
1821872797
Registry record updated Aug 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Residential Treatment FacilityTaxonomy code 323P00000X
Legal business name
IRONWOOD LAKE HOUSE
Doing business as
Ironwood lake House
Practice address
24 Pond Hill Rd
South China, ME 04358-5009
Phone
(310) 457-6302
Fax
(310) 457-6318
NPI assigned
Aug 22, 2023
Last updated
Aug 22, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
IRONWOOD MAINEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 22, 2023

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

Authorized official

Name
Debora Garcia
Title
RCM Manager
Phone
(310) 457-6302

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Residential Treatment Facility 323P00000X Primary

Addresses

Primary practice location

24 Pond Hill Rd
South China, ME 04358-5009

Mailing address

12424 Wilshire Blvd Ste 800
Los Angeles, CA 90025-1035
Phone (310) 457-6302

Other names 1

  • Ironwood lake House Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Ironwood Lake House3 organizations share this tax ID, including this one
Part of
Ironwood Lake House

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1692662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692662400000",
    "number": "1821872797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12424 WILSHIRE BLVD STE 800",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900251035",
            "telephone_number": "310-457-6302",
            "fax_number": "310-457-6318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 POND HILL RD",
            "city": "SOUTH CHINA",
            "state": "ME",
            "postal_code": "043585009",
            "telephone_number": "310-457-6302",
            "fax_number": "310-457-6318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IRONWOOD LAKE HOUSE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IRONWOOD MAINE",
        "enumeration_date": "2023-08-22",
        "last_updated": "2023-08-22",
        "certification_date": "2023-08-22",
        "status": "A",
        "authorized_official_last_name": "GARCIA",
        "authorized_official_first_name": "DEBORA",
        "authorized_official_title_or_position": "RCM MANAGER",
        "authorized_official_telephone_number": "310-457-6302"
    },
    "taxonomies": [
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ironwood lake House",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in South China, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2023; 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.