MOUNTAIN LAKE CHILDREN'S RESIDENCE, INC. (NPI# 1255507497) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255507497 |
| Entity Type | Organization |
| Organization Name | MOUNTAIN LAKE CHILDREN'S RESIDENCE, INC. |
| Practice Address |
386 River Road Lake Placid NY 12946 |
| Practice Telephone | 5185234300 |
| Practice Fax Number | 5185235322 |
| Mailing Telephone | 5185234300 |
| Mailing Fax Number | 5185235322 |
| Enumeration Date | 2008-05-07 |
| Last Update Date | 2015-04-08 |
| Authorized Official Name | MRS. CAROL M PREVOST (CEO) |
| Authorized Official Telephone | 5185234300 |
| Is Organization Subpart | Y |
| Parent Organization Name | WINDWOOD MEADOW, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 01949242 | 05 |
| Street Address |
386 RIVER ROAD |
| City | LAKE PLACID |
| State | NY |
| Zip Code | 12946 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376761411 | Barbara Lynn Lawrence | Technician/Technologist | 96 Nash Street, Lake Placid, NY 12946 | 2007-04-23 |
| 1437202728 | Lake Placid Central School District | Local Education Agency (LEA) | 50 Cummings Road, Lake Placid, NY 12946 | 2007-01-19 |
| 1700952652 | Marcia Jo Dareff-wenn | Social Worker | 18 Coyote Way, Lake Placid, NY 12946 | 2006-11-24 |
| 1891807079 | Herbert Vw Bergamini | General Practice | 26 Swiss Road, Lake Placid, NY 12946 | 2006-08-31 |
| 1235129701 | Lake Placid Volunteer Ambulance Service Inc | Ambulance | 388 Mill Pond Drive, Lake Placid, NY 12946 | 2005-10-26 |
| 1982949251 | Colleen Porter | Occupational Therapist | 185 Old Military Rd, Lake Placid, NY 12946 | 2012-11-28 |
| 1053595496 | Richard S. Donela | Podiatrist | Adirondack Medical Center, 29 Church St., Lake Placid, NY 12946 | 2007-12-20 |
| 1861578502 | Karen L Merrihew-knox | Physical Therapist | 34 School St, Lake Placid Central School, Lake Placid, NY 12946 | 2006-10-27 |
| 1548328149 | Andrew James Donatello | Specialist/Technologist | 10 Northwood Rd, Lake Placid, NY 12946-0062 | 2006-12-05 |
| 1407939853 | Karen Ann White | Psychologist | 55 Barn Rd, Suite 203, Lake Placid, NY 12946-1050 | 2006-10-21 |
| Find all providers in zip 12946 | ||||
| Taxonomy Code | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013360361 | Jesse Brand | Residential Treatment Facility, Emotionally Disturbed Children | 60 Forrest Ave, Shirley, NY 11967-1955 | 2016-07-21 |
| 1285040600 | Sean Bedford | Residential Treatment Facility, Emotionally Disturbed Children | 7 Scarlett Ct, Apt 16, New City, NY 10956-5030 | 2014-07-07 |
| 1336575703 | Education Plus Corp | Residential Treatment Facility, Emotionally Disturbed Children | 431 Chapel Hill Rd, Hancock, NY 13783-2248 | 2013-09-17 |
| 1578905212 | Jewish Child Care Association | Residential Treatment Facility, Emotionally Disturbed Children | 671 Osborn St, Brooklyn, NY 11212-5745 | 2013-07-23 |
| 1538419973 | Scott Fierman Services | Residential Treatment Facility, Emotionally Disturbed Children | 31 Ohayo Mountain Rd, Woodstock, NY 12498-1441 | 2012-09-13 |
| 1821374448 | Takenya Tanyette Benbow | Residential Treatment Facility, Emotionally Disturbed Children | 135 West 50th Street 6th Floor, Jewish Board of Family and Children Services, New York, NY 10020 | 2011-10-27 |
| 1720377757 | Lidia Kupiec Lmsw | Residential Treatment Facility, Emotionally Disturbed Children | 178 Bradley Rd, Scarsdale, NY 10583-6343 | 2011-03-30 |
| 1912202482 | Adirondack Leadership Expeditions | Residential Treatment Facility, Emotionally Disturbed Children | 82 Church St, Saranac Lake, NY 12983-1858 | 2011-01-14 |
| 1891016192 | Access: Supports for Living Inc | Residential Treatment Facility, Emotionally Disturbed Children | 87 Little Britain Rd, Newburgh, NY 12550-5113 | 2010-06-21 |
| 1356675151 | Ohel Childrens Home & Family Services | Residential Treatment Facility, Emotionally Disturbed Children | 1498 E 34 St, Brooklyn, NY 11234 | 2009-09-25 |
| Find all providers with the same taxonomy | ||||
| City | LAKE PLACID |
| Zip Code | 12946 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.