# GREAT LAKES CARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639075880
- **Authorized official:** MR. YVES MPUNDU (AUTHOURISED REPRESENTATIVE)
- **Authorized official phone:** (207) 900-4164

## Contact information

- **Practice address:** 3091 N CASALOMA DR APT 225, APPLETON, WI 54913-9066
- **Practice address phone:** (207) 900-4164
- **Mailing address:** 3091 N CASALOMA DR APT 225, APPLETON, WI 54913-9066
- **Mailing address phone:** (207) 900-4164

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 310400000X | Assisted Living Facility | — | NULL | — |
| 311ZA0620X | Adult Care Home Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 10/15/2026
- **Last updated:** 10/15/2026