| Organization Name: | GREAT LAKES HOME CARE INC. |
| NPI Number: | 1316217219 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARY-KIM EGERE (ADMINISTRATOR) |
| Mailing Address: | 6000 Bass Lake Rd Ste 104 Crystal |
| State: | MN US |
| Postal Code: | 554292753 |
| Phone Number: | 7635376651 |
| Fax Number: | 7635354288 |
| NPI Enumeration Date: | 01/09/2012 |
| NPI Last Update Date: | 01/09/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 253Z00000X |
| License Number: | 353271 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MN |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | In Home Supportive Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An In Home Supportive Care Agency provides services in the patient |