Provider Demographics
NPI:1114154978
Name:GREATER LAKES TRANSPORTATION
Entity Type:Organization
Organization Name:GREATER LAKES TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-456-0738
Mailing Address - Street 1:53 1/2 W HURON ST
Mailing Address - Street 2:SUITE #221
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48342-2121
Mailing Address - Country:US
Mailing Address - Phone:248-456-0738
Mailing Address - Fax:248-456-0739
Practice Address - Street 1:53 1/2 W HURON ST
Practice Address - Street 2:SUITE #221
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-2121
Practice Address - Country:US
Practice Address - Phone:248-456-0738
Practice Address - Fax:248-456-0739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)