Organization
GREAT LAKES ADULT LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GLORIA NKECHI MBANU REGISTER NURSE (PRESIDENT)
(219) 980-1625
Entity
Organization
Contact information
Practice address
3700 JACKSON ST, GARY, IN 46408-2226
(219) 980-1625
Mailing address
3843 MADISON ST, GARY, IN 46408-2728
(219) 980-1839
(219) 980-1893
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
01/10/2007
Last updated
08/22/2020
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