Organization
GREAT LAKES HOME MODIFICATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID CHARLES RUSH (MANAGING PARTNER)
(616) 261-4046
Entity
Organization
Contact information
Practice address
3555B BYRON CENTER AVE SW, WYOMING, MI 49519-3259
(616) 261-4046
Mailing address
3555B BYRON CENTER AVE SW, WYOMING, MI 49519-3259
(616) 261-4046
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
05/20/2015
Last updated
05/20/2015
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