Provider Demographics
NPI:1013710847
Name:GREAT LAKES CARING HOSPICE NIN, LLC
Entity type:Organization
Organization Name:GREAT LAKES CARING HOSPICE NIN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE PRIVACY & SAFETY OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MONASTIERE
Authorized Official - Suffix:
Authorized Official - Credentials:CHC
Authorized Official - Phone:517-768-4373
Mailing Address - Street 1:3010 LYNDON B JOHNSON FWY STE 1100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-2712
Mailing Address - Country:US
Mailing Address - Phone:517-768-4373
Mailing Address - Fax:
Practice Address - Street 1:7030 POINTE INVERNESS WAY STE 230A
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-7925
Practice Address - Country:US
Practice Address - Phone:574-501-3137
Practice Address - Fax:877-376-2792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-28
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based