Organization
GREAT LAKES HOME HEALTH CARE , LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BERNADETTE MANUEL R.N.B.S.N (OWNER - CEO)
(586) 558-2950
Entity
Organization
Contact information
Practice address
28800 RYAN RD, SUITE 325, WARREN, MI 48092-4272
(586) 558-2950
(586) 620-6019
Mailing address
28800 RYAN RD, SUITE 325, WARREN, MI 48092-4272
(586) 558-2950
(586) 620-6019
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
237738
MEDICARE NGS
MI
Enumeration date
06/26/2007
Last updated
07/30/2009
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