OrganizationActive
Big Lake Country Club
NPI 1154580835 · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Houston, AK
Provider details
- NPI number
- 1154580835
- Entity type
- Organization
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityResidential Treatment Facilities
- Authorized official
- Jess Adams, Staff Office
- License
- 100554 (AK)
Mailing address
Po Box 299136
Wasilla, AK 99629-9136
Registry dates
- Enumerated
- 2008-06-06
- Last updated
- 2009-07-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.