Provider Demographics
NPI:1952506354
Name:GREAT LAKES EMPLOYMENT SERVICES LTD
Entity Type:Organization
Organization Name:GREAT LAKES EMPLOYMENT SERVICES LTD
Other - Org Name:GREAT LAKES HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:PRUETER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-872-5343
Mailing Address - Street 1:1021 SANDUSKY ST
Mailing Address - Street 2:STE B
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-3120
Mailing Address - Country:US
Mailing Address - Phone:419-872-4343
Mailing Address - Fax:419-872-7465
Practice Address - Street 1:1021 SANDUSKY ST
Practice Address - Street 2:STE B
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-3120
Practice Address - Country:US
Practice Address - Phone:419-872-4343
Practice Address - Fax:419-872-7465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1656351251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health