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General NPI Number Information
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NPI Number | 1922300714
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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 | 11/30/2010
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 3120 10TH STREET SUITE 2
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City | MENOMINEE
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State | MI
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Zip | 49858
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Country | US
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Telephone | 906-863-4153
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Fax | 906-863-4153
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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. GREG M. TOUTANT
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Credential | M.ED.
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 550027
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License Number State | MI
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