MEDICARE: GREAT LAKES RECOVERY CENTERS

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1669289138
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREAT LAKES RECOVERY CENTERS

Provider Business Mailing Address
First Line	:	100 MALTON RD
Second Line	:
City	:	NEGAUNEE
State	:	MI
Zip	:	49866-2001
Country	:	US
Telephone Number	:	906-228-9699
Fax Number	:	906-458-1386

Provider Business Practice Location Address
First Line	:	216 N 12TH ST
Second Line	:
City	:	ESCANABA
State	:	MI
Zip	:	49829-3528
Country	:	US
Telephone Number	:	906-458-1386
Fax Number	:	906-458-1386

Authorized Official
Title or Position	:	SR ACCOUNTANT
Name	:	LAURA URIAS GIUCHIN
Credential	:
Telephone Number	:	906-228-9699

Provider Enumeration Date	:	12/17/2024
Last Update Date	:	12/05/2025

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