Healthcare Provider Details

I. General information

NPI: 1629717939
Provider Name (Legal Business Name): GREAT LAKES RECOVERY CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2022
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 MESNARD ST.
L'ANSE MI
49946
US

IV. Provider business mailing address

100 MALTON RD
NEGAUNEE MI
49866-2001
US

V. Phone/Fax

Practice location:
  • Phone: 906-275-4990
  • Fax: 906-553-6029
Mailing address:
  • Phone: 906-228-9699
  • Fax: 906-228-0505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GREG TOUTANT
Title or Position: CEO
Credential:
Phone: 906-228-9699