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General NPI Number Information
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NPI Number | 1497069173
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Entity Type | Organization
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Legal Business Name | GREAT LAKES HOME HEALTH CARE AGENCY, LLC
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Dates
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Enumeration Date | 08/04/2010
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Last Update Date | 06/24/2020
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Provider Practice Location Address
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Address Line | 3226 FASHION SQUARE BLVD
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City | SAGINAW
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State | MI
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Zip | 48603-2461
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Country | US
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Telephone | 248-957-1999
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Fax |
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Provider Business Mailing Address
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Address Line | 30600 NORTHWESTERN HWY STE 245A
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334-3161
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Country | US
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Telephone | 248-957-1999
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JASON LAING
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Credential |
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Telephone | 248-957-1999
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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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