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General NPI Number Information
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NPI Number | 1568384113
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Entity Type | Organization
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Legal Business Name | GREATLAKES HOMECARE CENTER LLC
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Dates
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Enumeration Date | 07/27/2026
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Last Update Date | 07/27/2026
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Provider Practice Location Address
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Address Line | 42188 TODDMARK LN APT 17
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-5498
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Country | US
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Telephone | 603-289-4836
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Fax |
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Provider Business Mailing Address
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Address Line | 42188 TODDMARK LN APT 17
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-5498
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANDY IRBAHIM
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Credential |
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Telephone | 603-289-4836
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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