Healthcare Provider Details

I. General information

NPI: 1790378909
Provider Name (Legal Business Name): GREAT LAKES COMMUNITY ACTION PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2021
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 S FRONT ST
FREMONT OH
43420-3021
US

IV. Provider business mailing address

PO BOX 590
FREMONT OH
43420-0590
US

V. Phone/Fax

Practice location:
  • Phone: 419-334-8911
  • Fax:
Mailing address:
  • Phone: 419-334-8911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: RUTHANN HOUSE
Title or Position: PRESIDENT/CEO
Credential:
Phone: 419-334-8911