Organization
MYSTIC CREEK, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE COOK (OWNER)
(608) 538-3781
Entity
Organization
Contact information
Practice address
12489 STATE HIGHWAY 56, VIOLA, WI 54664-8914
(608) 538-3781
(608) 538-3782
Mailing address
17969 WILSON SPRINGS RD, RICHLAND CENTER, WI 53581-8588
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
02/23/2016
Last updated
01/22/2026
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