NPI 1376828228

Great Lakes Senior Care, LLC

Organisation Physical Disabilities Residential Treatment Facility Portage, IN

Practice location

Address: 6040 Lute Rd, Portage, IN 46368-5008
Phone: (219) 841-7559
Fax: (219) 763-4858

Authorised official

Name: James R Vanvliet
Title: Managing Partner
Phone: (219) 841-7559

Registered specialties

Physical Disabilities Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320700000X Licence 110126101 (IN)

Other Residential Treatment Facility, Physical Disabilities providers in Indiana →

Registry record

NPI: 1376828228
Entity type: Organization
NPI issued: 11 Oct 2011
Record last updated: 11 Oct 2011

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.