Organization
GREAT LAKES PERSONAL CARE SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LINDA COLEMAN CLEVELAND (PRESIDENT)
(877) 954-5727
Entity
Organization
Contact information
Practice address
2009 W GLEN PARK AVE, SUITE B, GRIFFITH, IN 46319-3735
(877) 954-5727
(866) 941-6921
Mailing address
2158 45TH ST, #245, HIGHLAND, IN 46322-3742
(877) 954-5727
(866) 941-6921
Taxonomy
Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
140129981
IN
253Z00000X
In Home Supportive Care Agency
Primary
140129981
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201147030A
LEGACY PROVIDER ID / LPI
IN
05
—
201147030A
—
IN
Enumeration date
07/31/2015
Last updated
08/04/2015
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