| Organization Name: | GREAT LAKES RECOVERY CENTERS |
| NPI Number: | 1316351224 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GREG TOUTANT (CEO) |
| Mailing Address: | 97 S. 4th Street Suite C Ishpeming |
| State: | MI US |
| Postal Code: | 49849 |
| Phone Number: | 9062289699 |
| Fax Number: | 9062280505 |
| NPI Enumeration Date: | 06/18/2014 |
| NPI Last Update Date: | 07/14/2015 |
| 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: | |