Healthcare Provider Details

I. General information

NPI: 1669289138
Provider Name (Legal Business Name): GREAT LAKES RECOVERY CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2024
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 N 12TH ST
ESCANABA MI
49829-3528
US

IV. Provider business mailing address

100 MALTON RD
NEGAUNEE MI
49866-2001
US

V. Phone/Fax

Practice location:
  • Phone: 906-458-1386
  • Fax: 906-458-1386
Mailing address:
  • Phone: 906-228-9699
  • Fax: 906-458-1386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAURA URIAS GIUCHIN
Title or Position: SR ACCOUNTANT
Credential:
Phone: 906-228-9699