Organization
GREAT LAKES ADULT DAY SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENYATTA LEGETTE RN (ADMINISTRATOR)
(313) 530-1161
Entity
Organization
Contact information
Practice address
19194 AUGUSTA CT, LIVONIA, MI 48152-4016
(313) 530-1161
Mailing address
19194 AUGUSTA CT, LIVONIA, MI 48152-4016
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
—
—
163WC2100X
Continence Care Registered Nurse
—
—
163WG0600X
Gerontology Registered Nurse
—
—
163WH1000X
Hospice Registered Nurse
Primary
4704275716
MI
163WN1003X
Nutrition Support Registered Nurse
—
—
163WP0000X
Pain Management Registered Nurse
—
—
163WW0000X
Wound Care Registered Nurse
11091605
WI
251E00000X
Home Health Agency
—
—
251J00000X
Nursing Care Agency
—
—
252Y00000X
Early Intervention Provider Agency
—
—
372500000X
Chore Provider
—
—
376K00000X
Nurse's Aide
—
—
385H00000X
Respite Care
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8278228
—
MI
Enumeration date
08/03/2017
Last updated
09/11/2025
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