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GREAT LAKES SENIOR CARE, LLC

Residential Treatment Facilities Residential Treatment Facility, Physical Disabilities

Provider NPI: 1376828228

Organization Information:
Organization Name:  GREAT LAKES SENIOR CARE, LLC
Organization is not Subpart
Authorized Official:  JAMES R VANVLIET  MANAGING PARTNER  219-841-7559

Practice Location:
6040 LUTE RD  PORTAGE, IN 46368-5008 US
Tel: 219-841-7559  Fax: 219-763-4858

Business Mailing Address:
6040 LUTE RD  PORTAGE, IN 46368-5008 US
Tel: 219-841-7559  Fax: 219-763-4858

NPI Information:
NPI: 1376828228
Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y320700000XResidential Treatment Facilities
Residential Treatment Facility, Physical Disabilities
IN110126101

Other Provider Identifiers:

IssuerNumberStateType
2010300000 AIN05



American Medical Association 2012 taxonomy code information

Code: 320700000X

Type:

Classification:



Definition:



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