Provider Demographics
NPI:1285965160
Name:GREAT LAKES IN-HOME HEALTHCARE
Entity type:Organization
Organization Name:GREAT LAKES IN-HOME HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GENISE
Authorized Official - Middle Name:L
Authorized Official - Last Name:REASEOLDENBURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-465-6606
Mailing Address - Street 1:3800 W FIKE RD
Mailing Address - Street 2:
Mailing Address - City:COLEMAN
Mailing Address - State:MI
Mailing Address - Zip Code:48618-8534
Mailing Address - Country:US
Mailing Address - Phone:989-465-6606
Mailing Address - Fax:989-465-6386
Practice Address - Street 1:3800 W FIKE RD
Practice Address - Street 2:
Practice Address - City:COLEMAN
Practice Address - State:MI
Practice Address - Zip Code:48618-8534
Practice Address - Country:US
Practice Address - Phone:989-465-6606
Practice Address - Fax:989-465-6386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-17
Last Update Date:2010-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health