Great Lakes Senior Care, LLC

NPI #1376828228 in Portage, Indiana

Provider Information

NPI Number
1376828228
Entity Type
Organization
Organization Name
Great Lakes Senior Care, LLC
Primary Specialty
Residential Treatment Facility, Physical Disabilities
Enumeration Date
Oct 11, 2011
Last Updated
Oct 11, 2011

Practice Location

Address
6040 LUTE RD
State
Indiana
ZIP Code
46368-5008
Phone
(219) 841-7559

Authorized Official

Name
MR. JAMES R VANVLIET
Title
MANAGING PARTNER
Phone
(219) 841-7559

Specialties & Taxonomy Codes

Specialty
Residential Treatment Facility, Physical Disabilities

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