Provider Demographics
NPI:1114393576
Name:GREAT LAKES CARING HOME HEALTH C MI, LLC
Entity Type:Organization
Organization Name:GREAT LAKES CARING HOME HEALTH C MI, LLC
Other - Org Name:GREAT LAKES CARING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:NIELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-780-9500
Mailing Address - Street 1:900 COOPER ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-3398
Mailing Address - Country:US
Mailing Address - Phone:517-780-9500
Mailing Address - Fax:
Practice Address - Street 1:3100 WEST RD
Practice Address - Street 2:BUILDING 2 SUITE 110
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-6369
Practice Address - Country:US
Practice Address - Phone:517-780-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health