Big Lake Country Club, LLC

NPI #1528746153 in Houston, Alaska

Provider Information

NPI Number: 1528746153
Entity Type: Organization
Organization Name: Big Lake Country Club, LLC
Primary Specialty: Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Jul 5, 2023
Last Updated: Jul 5, 2023

Practice Location

Address: 12528 W. HAWK LANE
City: Houston
State: Alaska
ZIP Code: 99694
Phone: (907) 232-8466

Authorized Official

Name: STEPHEN PHILLIP GEDDES
Title: MANAGER
Phone: (907) 250-6605

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities	320900000X
Residential Treatment Facility, Intellectual and/or Developmental Disabilities	320600000X	Primary

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