Provider Demographics
NPI:1700222742
Name:GREAT LAKES CARE COMPANIONS
Entity Type:Organization
Organization Name:GREAT LAKES CARE COMPANIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-627-0563
Mailing Address - Street 1:4308 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROWN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48416-9711
Mailing Address - Country:US
Mailing Address - Phone:810-627-0563
Mailing Address - Fax:810-346-3125
Practice Address - Street 1:4308 MAIN ST
Practice Address - Street 2:
Practice Address - City:BROWN CITY
Practice Address - State:MI
Practice Address - Zip Code:48416-9711
Practice Address - Country:US
Practice Address - Phone:810-627-0563
Practice Address - Fax:810-346-3125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services