Organization
GRAND LAKE OPERATIONS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK S MCCLEERY (CPA/MEMBER)
(419) 238-0715
Entity
Organization
Contact information
Practice address
1035 HAGER STREET, SAINT MARYS, OH 45885
(419) 394-3308
(419) 394-3300
Mailing address
120 W MAIN ST STE 200, VAN WERT, OH 45891-1761
(419) 238-0715
(419) 238-4814
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
—
—
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
08/07/2019
Last updated
06/26/2020
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