Big Lake Country Club

NPI #1154580835 in Houston, Alaska

Provider Information

NPI Number: 1154580835
Entity Type: Organization
Organization Name: Big Lake Country Club
Primary Specialty: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Jun 6, 2008
Last Updated: Jul 22, 2009

Practice Location

Address: 12528 HAWK LANE
City: Houston
State: Alaska
ZIP Code: 99694-2528
Phone: (907) 892-6944

Authorized Official

Name: JESS G ADAMS
Title: STAFF OFFICE
Phone: (907) 892-6944

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities	320900000X	Primary

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