Organization
BIG LAKE COUNTRY CLUB, LLC
Active
Parent organization
BIG LAKE COUNTRY CLUB LLC
Other names
Big Lake Country Club I
Organization subpart
Yes
Provider details
NPI number
Legal business name
BIG LAKE COUNTRY CLUB LLC
Authorized official
STEPHEN PHILLIP GEDDES (MANAGER)
(907) 250-6605
Entity
Organization
Contact information
Practice address
12528 W. HAWK LANE, HOUSTON, AK 99694
(907) 232-8466
Mailing address
PO BOX 520069, BIG LAKE, AK 99652-0069
(907) 232-8466
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
07/05/2023
Last updated
07/05/2023
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