MEDICARE: GREAT LAKES HOME HEALTH OHIO 2, 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1336579887
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREAT LAKES HOME HEALTH OHIO 2, 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	:	800-379-1600
Fax Number	:	903-537-8420

Provider Business Practice Location Address
First Line	:	5966 HEISLEY RD STE 100
Second Line	:
City	:	MENTOR
State	:	OH
Zip	:	44060-5849
Country	:	US
Telephone Number	:	440-358-9200
Fax Number	:	440-358-9201

Authorized Official
Title or Position	:	DIR LICENSE & REGULATORY COMPLIANCE
Name	:	ANGEL STANSBURY
Credential	:
Telephone Number	:	337-344-2141

Provider Enumeration Date	:	11/20/2013
Last Update Date	:	02/06/2026

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