Organization
GREAT LAKES RECOVERY MISSION, LLC
Active
Parent organization
GREAT LAKES RECOVERY MISSION, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
GREAT LAKES RECOVERY MISSION, LLC
Authorized official
JOSHUA BUKOFFSKY (CHIEF EXECUTIVE OFFICER)
(586) 491-1057
Entity
Organization
Contact information
Practice address
427 W 4TH AVE, FLINT, MI 48503-2403
(810) 275-2690
Mailing address
5099 W FARRAND RD, CLIO, MI 48420-8215
(586) 491-1057
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
12/13/2021
Last updated
12/13/2021
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