Provider Demographics
NPI:1356691893
Name:GREAT LAKES HOME HEALTHCARE SERVICES, INC
Entity type:Organization
Organization Name:GREAT LAKES HOME HEALTHCARE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PHID
Authorized Official - Middle Name:
Authorized Official - Last Name:ONWUZURIKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-779-4741
Mailing Address - Street 1:28592 ORCHARD LAKE RD STE 310
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2903
Mailing Address - Country:US
Mailing Address - Phone:248-623-8400
Mailing Address - Fax:248-623-8400
Practice Address - Street 1:28592 ORCHARD LAKE RD STE 310
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2903
Practice Address - Country:US
Practice Address - Phone:248-623-8400
Practice Address - Fax:248-623-8448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-12
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health