Healthcare Provider Details

I. General information

NPI: 1326478876
Provider Name (Legal Business Name): GREAT LAKES HOME HEALTH OHIO 1, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2013
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 EXECUTIVE PKWY SUITE 206
TOLEDO OH
43606-1326
US

IV. Provider business mailing address

3010 LYNDON B JOHNSON FWY STE 1100
DALLAS TX
75234-2712
US

V. Phone/Fax

Practice location:
  • Phone: 419-536-6748
  • Fax: 419-536-6784
Mailing address:
  • Phone: 800-379-1600
  • Fax: 903-537-8420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KATIE MONASTIERE
Title or Position: COMPLIANCE PRIVACY&SAFETY OFFICER
Credential:
Phone: 800-379-1600