# GREAT LAKE HOME CARE L L C

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

## Provider details

- **NPI number:** 1952565970
- **Authorized official:** MRS. RUBY DALE (OWNER)
- **Authorized official phone:** (313) 537-5848

## Contact information

- **Practice address:** 30800 TELEGRAPH RD STE 2815, BINGHAM FARMS, MI 48025-4544
- **Practice address phone:** (313) 537-5848
- **Practice address fax:** (248) 987-6919
- **Mailing address:** 17070 W 12 MILE RD, STE D, SOUTHFIELD, MI 48076-2116
- **Mailing address phone:** (313) 537-5848
- **Mailing address fax:** (248) 987-6919

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 07/18/2008
- **Last updated:** 05/18/2022