Provider Demographics
NPI:1134313687
Name:GREAT LAKES HEALTHCARE RESOURCES, LLC
Entity Type:Organization
Organization Name:GREAT LAKES HEALTHCARE RESOURCES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:R
Authorized Official - Last Name:RUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-261-4046
Mailing Address - Street 1:3555B BYRON CENTER AVE SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-3259
Mailing Address - Country:US
Mailing Address - Phone:616-261-4046
Mailing Address - Fax:616-261-5838
Practice Address - Street 1:3555B BYRON CENTER AVE SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-3259
Practice Address - Country:US
Practice Address - Phone:616-261-4046
Practice Address - Fax:616-261-5838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health