Healthcare Provider Details

I. General information

NPI: 1659253870
Provider Name (Legal Business Name): GREAT LAKES HOME HEALTH OHIO 3, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 E WILSON BRIDGE RD STE 310
WORTHINGTON OH
43085-2327
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 614-363-0196
  • Fax: 903-537-8420
Mailing address:
  • Phone: 517-768-4373
  • Fax:

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 LYNN MONASTIERE
Title or Position: COMPLIANCE PRIVACY & SAFETY OFFICER
Credential:
Phone: 517-768-4373