NPI 1154580835

Big Lake Country Club

Organisation Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility Houston, AK

Practice location

Address: 12528 Hawk Lane, Houston, AK 99694-2528
Phone: (907) 892-6944
Mailing address: PO Box 299136, Wasilla, AK 99629-9136

Authorised official

Name: Jess G Adams
Title: Staff Office
Phone: (907) 892-6944

Registered specialties

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

Residential Treatment Facilities Taxonomy 320900000X Licence 100554 (AK)

Other Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities providers in Alaska →

Registry record

NPI: 1154580835
Entity type: Organization
NPI issued: 6 Jun 2008
Record last updated: 22 Jul 2009

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.