Provider Demographics
NPI:1770874562
Name:GREAT LAKES IN HOME HCS, INC.
Entity type:Organization
Organization Name:GREAT LAKES IN HOME HCS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR - CORPORATE COMPLIANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STECHSCHULTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-999-2010
Mailing Address - Street 1:404 W NEPESSING ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-2150
Mailing Address - Country:US
Mailing Address - Phone:810-667-9600
Mailing Address - Fax:810-245-9080
Practice Address - Street 1:404 W NEPESSING ST
Practice Address - Street 2:SUITE G
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-2150
Practice Address - Country:US
Practice Address - Phone:810-667-9600
Practice Address - Fax:810-245-9080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-27
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health