MEDICARE: LAKELAND VILLAGE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	315P00000X	Intellectual Disabilities Intermediate Care Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366594228
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKELAND VILLAGE

Provider Business Mailing Address
First Line	:	PO BOX 200
Second Line	:
City	:	MEDICAL LAKE
State	:	WA
Zip	:	99022-0200
Country	:	US
Telephone Number	:	509-299-1001
Fax Number	:	509-299-1070

Provider Business Practice Location Address
First Line	:	S 2320 SALNAVE ROAD
Second Line	:
City	:	MEDICAL LAKE
State	:	WA
Zip	:	99022-0200
Country	:	US
Telephone Number	:	509-299-1001
Fax Number	:	509-299-1070

Authorized Official
Title or Position	:	SUPERINTENDENT
Name	:	MRS. KATHRYN A. MONTAGUE
Credential	:
Telephone Number	:	509-299-1001

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	08/22/2020

Similar Medicare Providers

1790851228 — MR. ROBERT CHARLES KITTAMS RPH.
Practice Location Address:

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1457414138 — WASHINGTON STATE DEPT OF SOCIAL AND HEALTH SERVICES
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1780734509 — LAKELAND VILLAGE NURSING FACILITY
Practice Location Address:

S 2320 SALNAVE ROAD
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1689864159 — RUTH ANN OMAN ARNP
Practice Location Address:

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1760536072 — HADLEY LUZERNE CENTRAL SCHOOL DISTRICT
Practice Location Address:

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Directions to “LAKELAND VILLAGE ” Practice Location

Language	Start Address	Practice Location

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