Provider Demographics
NPI:1871115568
Name:GREAT LAKES SENIOR HOME CARE
Entity type:Organization
Organization Name:GREAT LAKES SENIOR HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OSMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ISSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-598-1272
Mailing Address - Street 1:17325 EUCLID AVE STE 4081
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44112-1277
Mailing Address - Country:US
Mailing Address - Phone:614-598-1272
Mailing Address - Fax:
Practice Address - Street 1:17325 EUCLID AVE STE 4081
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-1277
Practice Address - Country:US
Practice Address - Phone:614-598-1272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-15
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health