Organization
GREAT LAKES REGIONAL CARE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. HIRAM ZAYAS MASTER OF SCIENCE (CEO)
(269) 449-8291
Entity
Organization
Contact information
Practice address
207 NORTH AVE, BATTLE CREEK, MI 49017-3430
(269) 964-8000
Mailing address
PO BOX 139, BATTLE CREEK, MI 49016-0139
(269) 964-8000
(269) 963-0912
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
AS130069760
MI
320800000X
Mental Illness Community Based Residential Treatment Facility
AS130081006
MI
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
AS130069760
MI
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
AS130081006
MI
Other
Enumeration date
06/16/2011
Last updated
06/16/2011
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