Healthcare Provider Details

I. General information

NPI: 1023975372
Provider Name (Legal Business Name): GREAT LAKES CARE AT HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2026
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3561 EUCLID DR
TROY MI
48083-5708
US

IV. Provider business mailing address

3561 EUCLID DR
TROY MI
48083-5708
US

V. Phone/Fax

Practice location:
  • Phone: 586-804-4247
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SUNNY JAIGIRDAR
Title or Position: CEO
Credential:
Phone: 586-804-4247