OrganizationActive
A Great Place to Stay LLC
NPI 1053949404 · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Lake Villa, IL
Provider details
- NPI number
- 1053949404
- Entity type
- Organization
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityResidential Treatment Facilities
- Authorized official
- Veronica Clark, President
Mailing address
716 Park Ave
Beaver Dam, WI 53916-2204
Registry dates
- Enumerated
- 2020-03-31
- Last updated
- 2020-03-31
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.