Provider Demographics
NPI:1457515652
Name:GREAT LAKES HOME CARE LLC
Entity Type:Organization
Organization Name:GREAT LAKES HOME CARE LLC
Other - Org Name:GREAT LAKES HOME NURSING CARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MBR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-615-2085
Mailing Address - Street 1:PO BOX 441
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48376-0441
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23534 STONEHENGE BLVD
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-3773
Practice Address - Country:US
Practice Address - Phone:248-615-2085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health