Provider Demographics
NPI:1669289138
Name:GREAT LAKES RECOVERY CENTERS
Entity type:Organization
Organization Name:GREAT LAKES RECOVERY CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:URIAS
Authorized Official - Last Name:GIUCHIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-228-9699
Mailing Address - Street 1:100 MALTON RD
Mailing Address - Street 2:
Mailing Address - City:NEGAUNEE
Mailing Address - State:MI
Mailing Address - Zip Code:49866-2001
Mailing Address - Country:US
Mailing Address - Phone:906-228-9699
Mailing Address - Fax:906-458-1386
Practice Address - Street 1:216 N 12TH ST
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-3528
Practice Address - Country:US
Practice Address - Phone:906-458-1386
Practice Address - Fax:906-458-1386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)