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General NPI Number Information
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NPI Number | 1588833404
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Entity Type | Organization
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Legal Business Name | GREAT LAKES RECOVERY CENTERS
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Dates
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Enumeration Date | 02/25/2008
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 2655 ASHMUN ST
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City | SAULT SAINTE MARIE
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State | MI
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Zip | 49783-3711
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Country | US
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Telephone | 906-632-9809
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Fax | 906-632-2370
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Provider Business Mailing Address
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Address Line | 100 MALTON RD
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City | NEGAUNEE
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State | MI
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Zip | 49866-2001
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Country | US
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Telephone | 906-228-9699
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Fax | 906-228-0505
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Authorized Official
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Title or Position | CEO
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Name | MR. GREGORY MILES TOUTANT
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Credential | MS
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Telephone | 906-228-9699
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 170045
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License Number State | MI
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