# MYSTIC CREEK, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356700025
- **Authorized official:** DIANE COOK (OWNER)
- **Authorized official phone:** (608) 538-3781

## Contact information

- **Practice address:** 12489 STATE HIGHWAY 56, VIOLA, WI 54664-8914
- **Practice address phone:** (608) 538-3781
- **Practice address fax:** (608) 538-3782
- **Mailing address:** 17969 WILSON SPRINGS RD, RICHLAND CENTER, WI 53581-8588

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 310400000X | Assisted Living Facility | — | NULL | Yes |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | — | Yes |

## Other

- **Enumeration date:** 02/23/2016
- **Last updated:** 01/22/2026