Healthcare Provider Details

I. General information

NPI: 1033864954
Provider Name (Legal Business Name): GREAT LAKES RECOVERY CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2022
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MALTON RD SUITE 7 & SUITE 8
NEGAUNEE MI
49866
US

IV. Provider business mailing address

100 MALTON RD
NEGAUNEE MI
49866-2001
US

V. Phone/Fax

Practice location:
  • Phone: 906-464-0002
  • Fax: 906-464-4043
Mailing address:
  • Phone: 906-228-9699
  • Fax: 906-228-0505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. GREG TOUTANT
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: CEO
Phone: 906-228-9699