MEDICARE: GREAT LAKES CARING HOSPICE NIN, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1013710847
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREAT LAKES CARING HOSPICE NIN, LLC

Provider Business Mailing Address
First Line	:	3010 LYNDON B JOHNSON FWY STE 1100
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75234-2712
Country	:	US
Telephone Number	:	517-768-4373
Fax Number	:

Provider Business Practice Location Address
First Line	:	7030 POINTE INVERNESS WAY STE 230A
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-7925
Country	:	US
Telephone Number	:	574-501-3137
Fax Number	:	877-376-2792

Authorized Official
Title or Position	:	COMPLIANCE PRIVACY & SAFETY OFFICER
Name	:	KATIE MONASTIERE
Credential	:	CHC
Telephone Number	:	517-768-4373

Provider Enumeration Date	:	03/28/2025
Last Update Date	:	03/28/2025

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