Organization
A GREAT PLACE TO STAY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VERONICA CLARK (PRESIDENT)
(920) 204-2722
Entity
Organization
Contact information
Practice address
35580 N KNOWLES RD, LAKE VILLA, IL 60046-9026
(920) 204-2722
Mailing address
716 PARK AVE, BEAVER DAM, WI 53916-2204
(920) 204-2722
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
03/31/2020
Last updated
03/31/2020
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