| NPI | 1700563301 |
|---|---|
| Other Name | BIG LAKE COUNTRY CLUB I |
| Entity Type | Organization |
| Authorized Contact | STEPHEN PHILLIP GEDDES Manager 907-250-6605 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2023-07-05 |
| Last Update Date | 2023-07-05 |