Lake Grove Maple Valley | |
6 Farley Rd Wendell MA 01379-9706 | |
(978) 544-6913 | |
(978) 544-8672 |
Full Name | Lake Grove Maple Valley |
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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 |
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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 |
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Provider Enumeration Date | 02/12/2008 |
Last Update Date | 02/12/2008 |
Identifier | Type | State | Issuer |
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1841468980 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | (* (Not Available)) | Primary |