Organization
GREAT LAKES NURSING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EVAN KYLE PRUETER (CEO)
(419) 872-5343
Entity
Organization
Contact information
Practice address
25660 DIXIE HWY, PERRYSBURG, OH 43551-2167
(419) 872-5343
(419) 872-7464
Mailing address
25660 DIXIE HWY, PERRYSBURG, OH 43551-2167
(419) 872-5343
(419) 872-7464
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
OH
Other
Enumeration date
02/06/2008
Last updated
09/30/2009
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