1992007793 NPI number — GREAT LAKES WELLNESS & HOME HEALTH INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992007793 NPI number — GREAT LAKES WELLNESS & HOME HEALTH INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREAT LAKES WELLNESS & HOME HEALTH INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992007793
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 36391
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GROSSE POINTE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48236-0391
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-740-5282
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20550 VERNIER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARPER WOODS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48225-1413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-871-2067
Provider Business Practice Location Address Fax Number:
586-871-2113
Provider Enumeration Date:
11/30/2010

Additional Information

Authorized Official

Authorized Official Last Name:
WASHINGTON
Authorized Official First Name:
FRANCHELLA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
586-510-0620

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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