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General NPI Number Information
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NPI Number | 1649137688
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Entity Type | Organization
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Legal Business Name | GREAT LAKES FAMILY SERVICES
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Dates
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Enumeration Date | 01/09/2026
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Last Update Date | 01/09/2026
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Provider Practice Location Address
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Address Line | 17121 REDFORD ST APT 112
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City | DETROIT
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State | MI
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Zip | 48219-3244
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Country | US
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Telephone | 313-785-3020
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Fax |
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Provider Business Mailing Address
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Address Line | 17121 REDFORD ST APT 112
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City | DETROIT
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State | MI
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Zip | 48219-3244
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Country | US
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Telephone | 313-785-3020
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. DIAMOND JENKINS
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Credential |
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Telephone | 313-785-3020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 342000000X
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Taxonomy Name | Transportation Network Company
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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