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General NPI Number Information
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NPI Number | 1255507497
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Entity Type | Organization
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Legal Business Name | MOUNTAIN LAKE ACADEMY
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Dates
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Enumeration Date | 05/07/2008
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 386 RIVER ROAD
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City | LAKE PLACID
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State | NY
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Zip | 12946
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Country | US
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Telephone | 518-523-4300
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Fax | 518-523-5322
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Provider Business Mailing Address
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Address Line | 386 RIVER ROAD
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City | LAKE PLACID
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State | NY
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Zip | 12946
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Country | US
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Telephone | 518-523-4300
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Fax | 518-523-5322
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Authorized Official
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Title or Position | CEO
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Name | CHRISTOPHER MARIANO
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Credential |
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Telephone | 518-523-4300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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