Healthcare Provider Details

I. General information

NPI: 1588020374
Provider Name (Legal Business Name): GREAT LAKES RECOVERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2016
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 WRIGHT ST
MARQUETTE MI
49855-1955
US

IV. Provider business mailing address

100 MALTON RD
NEGAUNEE MI
49866-2001
US

V. Phone/Fax

Practice location:
  • Phone: 906-228-6545
  • Fax:
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 Number6801098960
License Number StateMI

VIII. Authorized Official

Name: MR. GREGORY MILES TOUTANT
Title or Position: CEO
Credential: MS
Phone: 906-228-9696