Provider Demographics
NPI:1992007793
Name:GREAT LAKES WELLNESS & HOME HEALTH INC
Entity Type:Organization
Organization Name:GREAT LAKES WELLNESS & HOME HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EMORY
Authorized Official - Middle Name:DARNELL
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DON
Authorized Official - Phone:313-740-5282
Mailing Address - Street 1:PO BOX 36391
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48236-0391
Mailing Address - Country:US
Mailing Address - Phone:313-740-5282
Mailing Address - Fax:
Practice Address - Street 1:21701 KELLY RD
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-2700
Practice Address - Country:US
Practice Address - Phone:313-740-5282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health