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Organization

GREAT LAKES SENIOR CARE, LLC

Active
Other names
Home Helpers
Organization subpart
No

Provider details

NPI number
Authorized official
MR. JAMES R VANVLIET (MANAGING PARTNER)
(219) 841-7559
Entity
Organization

Contact information

Practice address
6040 LUTE RD, PORTAGE, IN 46368-5008
(219) 841-7559
(219) 763-4858
Mailing address
6040 LUTE RD, PORTAGE, IN 46368-5008
(219) 841-7559
(219) 763-4858

Taxonomy

Speciality
Code
Description
License number
State
320700000X
Physical Disabilities Residential Treatment Facility
Primary
110126101
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2010300000 A
IN
Enumeration date
10/11/2011
Last updated
10/11/2011
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