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Organization
GREAT LAKES HOME MODIFICATION LLC
Active
Organization
GREAT LAKES HOME MODIFICATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID CHARLES RUSH (MANAGING PARTNER)
(616) 261-4046
Entity
Organization
Contact information
Practice address
3555B BYRON CENTER AVE SW, WYOMING, MI 49519-3259
(616) 261-4046
Mailing address
3555B BYRON CENTER AVE SW, WYOMING, MI 49519-3259
(616) 261-4046
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
NULL
Other
Enumeration date
05/20/2015
Last updated
05/20/2015
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