Healthcare Provider Details

I. General information

NPI: 1679742597
Provider Name (Legal Business Name): GREAT LAKES RECOVERY CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2655 ASHMUN ST.
SAULT STE. MARIE MI
49783
US

IV. Provider business mailing address

100 MALTON RD
NEGAUNEE MI
49866-2001
US

V. Phone/Fax

Practice location:
  • Phone: 906-632-9809
  • Fax: 906-632-2780
Mailing address:
  • Phone: 906-228-9699
  • Fax: 906-228-0505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number170028
License Number StateMI

VIII. Authorized Official

Name: MR. GREG MILES TOUTANT
Title or Position: GREG TOUTANT
Credential: MS
Phone: 906-228-9699