Provider Demographics
NPI:1346225661
Name:GREAT LAKES HOME HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:GREAT LAKES HOME HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:DEARY
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:517-780-9500
Mailing Address - Street 1:900 COOPER STREET
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 1:900 COOPER STREET
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-3398
Practice Address - Country:US
Practice Address - Phone:517-780-9500
Practice Address - Fax:517-780-9700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI874400145Medicaid
1093000001Medicare ID - Type Unspecified