Provider Demographics
NPI:1326478876
Name:GREAT LAKES HOME HEALTH OHIO 1, LLC
Entity Type:Organization
Organization Name:GREAT LAKES HOME HEALTH OHIO 1, LLC
Other - Org Name:ELARA CARING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMPLIANCE AND PRIVACY OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MONASTIERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-379-1600
Mailing Address - Street 1:3010 LYNDON B JOHNSON FWY STE 1100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-2712
Mailing Address - Country:US
Mailing Address - Phone:800-379-1600
Mailing Address - Fax:903-537-8420
Practice Address - Street 1:3425 EXECUTIVE PKWY
Practice Address - Street 2:SUITE 206
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1326
Practice Address - Country:US
Practice Address - Phone:419-536-6748
Practice Address - Fax:419-536-6784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-20
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
367730Medicare Oscar/Certification