MEDICARE: GREAT LAKES HOME HEALTH SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency	383512	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568440055
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREAT LAKES HOME HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	3010 LYNDON B JOHNSON FWY STE 1100
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75234-2712
Country	:	US
Telephone Number	:	800-379-1600
Fax Number	:	903-537-8420

Provider Business Practice Location Address
First Line	:	209 W. WASHINGTON STE. 450A
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49201-2393
Country	:	US
Telephone Number	:	517-435-3055
Fax Number	:	517-780-9700

Authorized Official
Title or Position	:	DIR LICENSE & REGULATORY COMPLIANCE
Name	:	ANGEL STANSBURY
Credential	:
Telephone Number	:	337-344-2141

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	02/06/2026

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Directions to “GREAT LAKES HOME HEALTH SERVICES, INC. ” Practice Location

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