NPI 1053949404

A Great Place to Stay LLC

Organisation Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility Lake Villa, IL

Practice location

Address: 35580 N Knowles Rd, Lake Villa, IL 60046-9026
Phone: (920) 204-2722
Mailing address: 716 Park Ave, Beaver Dam, WI 53916-2204

Authorised official

Name: Veronica Clark
Title: President
Phone: (920) 204-2722

Registered specialties

Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320900000X

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Registry record

NPI: 1053949404
Entity type: Organization
NPI issued: 31 Mar 2020
Record last updated: 31 Mar 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.