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LAKELAND VILLAGE
NPI 1366594228
Intermediate Care Facility, Intellectual Disabilities in Medical Lake, WA

Active since January 18, 2007CLIA 50D0066058 · Waiver
S 2320 SALNAVE ROAD, MEDICAL LAKE, WA 99022(509) 299-1001(509) 299-1070 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 23, 2026.

About Lakeland Village NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LAKELAND VILLAGE (NPI 1366594228) is a healthcare organization registered as an intermediate care facility, intellectual disabilities in Medical Lake, Washington and active in the NPI registry since January 2007. The organization holds a CLIA Waiver certificate valid through April 4, 2028 and lists Kathryn A. Montague, Superintendent, as its authorized official.

NPPES Registry Identity

NPI1366594228
Entity TypeOrganization
Primary Taxonomy315P00000X
Legal Business NameLAKELAND VILLAGE
Location AddressS 2320 SALNAVE ROADMedical Lake, WA 99022-0200
Mailing AddressPo Box 200Medical Lake, WA 99022-0200 · (509) 299-1001 · Fax (509) 299-1070
Phone(509) 299-1001
Fax(509) 299-1070
Organization SubpartNo
Authorized OfficialKathryn A. MontagueSuperintendent · (509) 299-1001
Enumeration DateJanuary 18, 2007
Last NPPES UpdateAugust 22, 2020
✔ NPI 1366594228 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyIntermediate Care Facility, Intellectual DisabilitiesNursing & Custodial Care Facilities
Taxonomy Code315P00000X
Definition
An intermediate care facility providing services for individuals with intellectual disabilities.
S 2320 SALNAVE ROAD, Medical Lake, WA 99022
Open in Google Maps ↗

Other Identifiers 1

Medicaid4012001WA

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 50D0066058

Lakeland Village Laboratory · Medical Lake, WA
Active · expires Apr 4, 2028
CLIA Number50D0066058
Laboratory TypeOther
Certificate Effective DateAugust 12, 2004
Certificate Expiration DateApril 4, 2028
Laboratory DirectorSaima Ahmad
Laboratory Phone(509) 299-1800
Laboratory LocationLakeland Village Laboratory2323 South Salnave Rd, Medical Lake, WA 99022
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

WASHINGTON STATE DEPT OF SOCIAL AND HEALTH SERVICES
Pharmacy (Long Term Care Pharmacy)
S 2320 SALNAVE ROAD
MEDICAL LAKE, WA 99022
Spokane County (509) 299-1948
LAKELAND VILLAGE NURSING FACILITY
Nursing Facility/Intermediate Care Facility
S 2320 SALNAVE ROAD
MEDICAL LAKE, WA 99022
Spokane County (509) 299-1989

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lakeland Village's NPI number?

The NPI number for Lakeland Village is 1366594228. It was assigned to this organization in the NPPES registry on January 18, 2007.

Where is Lakeland Village located?

Lakeland Village is located at S 2320 Salnave Road, Medical Lake, WA 99022. The listed phone number is (509) 299-1001.

What is Lakeland Village's specialty?

The primary specialty registered for this NPI is Intermediate Care Facility, Intellectual Disabilities with taxonomy code 315P00000X.

Does Lakeland Village hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 50D0066058) is associated with this NPI, valid through April 4, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Lakeland Village was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.