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General NPI Number Information
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NPI Number | 1275877037
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Entity Type | Organization
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Legal Business Name | GREAT LAKES COMPREHENSIVE CARE, LLC
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Dates
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Enumeration Date | 11/18/2012
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Last Update Date | 11/18/2012
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Provider Practice Location Address
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Address Line | 2685 GLENROSE ST
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City | AUBURN HILLS
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State | MI
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Zip | 48326-1908
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Country | US
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Telephone | 419-297-7057
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Fax | 248-282-0590
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Provider Business Mailing Address
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Address Line | 2685 GLENROSE ST
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City | AUBURN HILLS
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State | MI
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Zip | 48326-1908
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Country | US
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Telephone | 419-297-7057
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Fax | 248-282-0590
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RYAN PETER CHERNIAWSKI
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Credential | MBA
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Telephone | 419-297-7057
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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