NPIMap

Organization Active NPI

Great Lakes Recovery Mission, LLC

  • Substance Abuse Rehabilitation Facility
  • Flint, MI
National Provider Identifier
1063171593
Registry record updated Dec 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
GREAT LAKES RECOVERY MISSION, LLC
Practice address
433 W 4TH Ave
Flint, MI 48503-2403
Phone
(810) 275-2690
NPI assigned
Dec 13, 2021
Last updated
Dec 13, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
GREAT LAKES RECOVERY MISSION, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 13, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Joshua BukoffskyNPI 1992578744
Title
Chief Executive Officer
Phone
(586) 491-1057

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X Primary

Addresses

Primary practice location

433 W 4TH Ave
Flint, MI 48503-2403

Mailing address

5099 W Farrand Rd
Clio, MI 48420-8215
Phone (586) 491-1057

National Provider Directory

National Provider Directory
Tax ID family
Great Lakes Recovery Mission12 organizations share this tax ID, including this one
Part of
Great Lakes Recovery Mission

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1639353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639353600000",
    "number": "1063171593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5099 W FARRAND RD",
            "city": "CLIO",
            "state": "MI",
            "postal_code": "484208215",
            "telephone_number": "586-491-1057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "433 W 4TH AVE",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485032403",
            "telephone_number": "810-275-2690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES RECOVERY MISSION, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GREAT LAKES RECOVERY MISSION, LLC",
        "enumeration_date": "2021-12-13",
        "last_updated": "2021-12-13",
        "certification_date": "2021-12-09",
        "status": "A",
        "authorized_official_last_name": "BUKOFFSKY",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "586-491-1057"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flint, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.