Provider Demographics
NPI:1497069173
Name:GREAT LAKES HOME HEALTH CARE AGENCY, LLC
Entity Type:Organization
Organization Name:GREAT LAKES HOME HEALTH CARE AGENCY, LLC
Other - Org Name:THE CARE TEAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:LAING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-957-1999
Mailing Address - Street 1:30600 NORTHWESTERN HWY STE 245A
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3161
Mailing Address - Country:US
Mailing Address - Phone:248-957-1999
Mailing Address - Fax:
Practice Address - Street 1:3226 FASHION SQUARE BLVD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-2461
Practice Address - Country:US
Practice Address - Phone:248-957-1999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-04
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health