Provider Demographics
NPI:1417374075
Name:GREAT LAKES HOME HEALTHCARE SPECIALISTS, LLC
Entity Type:Organization
Organization Name:GREAT LAKES HOME HEALTHCARE SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:231-421-5036
Mailing Address - Street 1:3529 BRAYTON LN
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49685-7444
Mailing Address - Country:US
Mailing Address - Phone:123-164-2616
Mailing Address - Fax:
Practice Address - Street 1:3281 RACQUET CLUB DR UNIT A
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-4701
Practice Address - Country:US
Practice Address - Phone:231-421-5036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-20
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health