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General NPI Number Information
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NPI Number | 1881544229
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Entity Type | Organization
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Legal Business Name | GREAT LAKES RECOVERY MISSION, LLC
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Dates
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Enumeration Date | 02/03/2026
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Last Update Date | 02/03/2026
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Provider Practice Location Address
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Address Line | 74 S ELK ST
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City | SANDUSKY
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State | MI
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Zip | 48471-1354
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Country | US
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Telephone | 810-487-4676
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Fax | 810-496-4295
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Provider Business Mailing Address
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Address Line | 5099 W FARRAND RD
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City | CLIO
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State | MI
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Zip | 48420-8215
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Country | US
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Telephone | 810-487-4676
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Fax | 810-496-4295
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Authorized Official
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Title or Position | CEO
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Name | JOSHUA BUKOFFSKY
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Credential |
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Telephone | 586-491-1057
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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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 | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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