Healthcare Provider Details

I. General information

NPI: 1952988370
Provider Name (Legal Business Name): GREAT LAKES HOME HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 E WASHINGTON AVE STE 450A
JACKSON MI
49201-2393
US

IV. Provider business mailing address

3010 LYNDON B JOHNSON FWY STE 1100
DALLAS TX
75234-2712
US

V. Phone/Fax

Practice location:
  • Phone: 517-780-9500
  • Fax: 517-780-9700
Mailing address:
  • Phone: 517-768-4373
  • Fax: 903-537-8420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: KATIE MONASTIERE
Title or Position: COMPLIANCE & PRIVACY OFFICER
Credential:
Phone: 800-379-1600