=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619202447
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREAT LAKES RECOVERY CENTERS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2009
-----------------------------------------------------
Last Update Date | 12/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1500 SANDPOINT RD
-----------------------------------------------------
City | MUNISING
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49862-1406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 906-291-3400
-----------------------------------------------------
Fax | 906-464-4043
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 MALTON RD
-----------------------------------------------------
City | NEGAUNEE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49866-2001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 906-228-9699
-----------------------------------------------------
Fax | 906-228-0505
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | MR. GREGORY MILES TOUTANT
-----------------------------------------------------
Credential | MS, CCS, CAADC
-----------------------------------------------------
Telephone | 906-228-9699
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number | 020017
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------