| Organization Name: | GREAT LAKES RECOVERY CENTERS |
| NPI Number: | 1023493152 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GREGORY L PERTTULA (CFO) |
| Mailing Address: | 902 W. Sharon Avenue Houghton |
| State: | MI US |
| Postal Code: | 499312061 |
| Phone Number: | 9065239688 |
| Fax Number: | 9065239687 |
| NPI Enumeration Date: | 07/30/2015 |
| NPI Last Update Date: | 07/30/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM0801X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
| Taxonomy Definition: | |