BIG LAKE COUNTRY CLUB, LLC (NPI# 1639497415) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639497415 |
| Entity Type | Organization |
| Organization Name | BIG LAKE COUNTRY CLUB, LLC |
| Practice Address |
12528 Hawk Lane Houston AK 99694 |
| Mailing Address |
Po Box 299136 Wasilla AK 99629 |
| Practice Telephone | 9078926944 |
| Mailing Telephone | 9078926944 |
| Enumeration Date | 2010-05-04 |
| Last Update Date | 2010-12-15 |
| Authorized Official Name | MS. LYNDA PLETTNER (PRESIDENT / ADMINISTRATOR) |
| Authorized Official Telephone | 9078926944 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 251B00000X | Case Management | CMG | AK | Agencies |
| N | 251S00000X | Community/Behavioral Health | HCS | AK | Agencies |
| Y | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 940288 | AK | Residential Treatment Facilities |
| Street Address |
12528 HAWK LANE |
| City | HOUSTON |
| State | AK |
| Zip Code | 99694 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154503688 | Lynda J Plettner | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 12528 Hawk Lane, Houston, AK 99694-2528 | 2007-11-27 |
| 1093183279 | Cozy Acres LLC | Assisted Living Facility | 12528 Hawk Lane, Houston, AK 99694 | 2015-09-04 |
| 1164723516 | Jody Hall | Case Manager/Care Coordinator | 12528 Hawk Lane, Houston, AK 99694 | 2010-11-16 |
| 1598066938 | Stephen Phillip Geddes | Case Manager/Care Coordinator | 12528 Hawk Lane, Houston, AK 99694 | 2010-11-16 |
| 1932339942 | Big Lake Mental Health Services | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 12528 Hawk Lane, Houston, AK 99694-2528 | 2009-07-24 |
| 1154580835 | Big Lake Country Club | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 12528 Hawk Lane, Houston, AK 99694-2528 | 2008-06-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992132880 | Diane Marie Boyer-walker | Assisted Living Facility | 11269 Wasey Way, Houston, AK 99694 | 2013-10-09 |
| 1720369374 | Cheryl Lynne Page | Community Health Worker | 12370 W Bench Lake Dr, Houston, AK 99694 | 2011-09-08 |
| 1730388190 | Diane Marie Boyer | Home Health | 11269 West Wasey Way, Houston, AK 99694 | 2007-07-16 |
| 1841674082 | Courtney Hopkins | Case Manager/Care Coordinator | 11578 West Ballyshannon Dr., Houston, AK 99694-0133 | 2015-07-17 |
| 1851555007 | Teresa Ann Tangen | Case Manager/Care Coordinator | 12528 Hawk Ln, Houston, AK 99694-1252 | 2008-07-17 |
| Taxonomy Code | 320900000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
| A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
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| 1265047534 | Compassion Structured Living Center LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 13578 San Martin Ln, Houston, TX 77083-5135 | 2020-09-13 |
| 1871104299 | Shamira Ferguson | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 10901 Mist Ln Apt 5104, Houston, TX 77070-4488 | 2020-08-10 |
| 1205444015 | Homestays By Brown Little & Gurl LLC. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2017 Gillette St, Houston, TX 77006-1531 | 2020-07-17 |
| 1184258923 | Bamal Solutions LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 13939 Westheimer Rd, Houston, TX 77077-5358 | 2020-03-02 |
| 1063046712 | Oasis Hcs and Txhml Services Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 7930 Corporate Dr Apt 14, Houston, TX 77036-6533 | 2020-03-02 |
| 1942833850 | Big Trinity Cargo LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 7015 Pouter Dr, Houston, TX 77083-3530 | 2020-02-19 |
| 1285264721 | A1 Healthcare LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 10039 Bissonnet St Ste 219, Houston, TX 77036-7852 | 2020-01-23 |
| 1881237550 | Ark Infinitude | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2150 Bentworth Dr Apt 461, Houston, TX 77077-6223 | 2019-10-24 |
| 1821645532 | New Hope Hcs and Txhml Services Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 6260 Westpark Dr Ste 230, Houston, TX 77057-7411 | 2019-08-19 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.