Organization
BIG LAKE COUNTRY CLUB, LLC
Active
Organization
BIG LAKE COUNTRY CLUB, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LYNDA PLETTNER (PRESIDENT / ADMINISTRATOR)
(907) 892-6944
Entity
Organization
Contact information
Practice address
12528 HAWK LANE, HOUSTON, AK 99694
(907) 892-6944
Mailing address
PO BOX 299136, WASILLA, AK 99629
(907) 892-6944
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
CMG
AK
251S00000X
Community/Behavioral Health Agency
HCS
AK
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
940288
AK
Other
Enumeration date
05/04/2010
Last updated
07/05/2023
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