Great Lakes Home Care Inc.

Primary specialty

Nursing Care AgencyTaxonomy code 251J00000X

License

353271 Issued in MN

Legal business name

GREAT LAKES HOME CARE INC.

Practice address

6000 Bass Lake Rd Ste 104
Crystal, MN 55429-2753

Phone

(763) 537-6651

Fax

(763) 535-4288

NPI assigned

Jan 9, 2012

Last updated

Jan 9, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Mary-Kim Egere

Title

Administrator

Phone

(763) 537-6651

Specialties & licenses 2

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1326067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326067200000",
    "number": "1316217219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6000 BASS LAKE RD STE 104",
            "city": "CRYSTAL",
            "state": "MN",
            "postal_code": "554292753",
            "telephone_number": "763-537-6651",
            "fax_number": "763-535-4288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6000 BASS LAKE RD STE 104",
            "city": "CRYSTAL",
            "state": "MN",
            "postal_code": "554292753",
            "telephone_number": "763-537-6651",
            "fax_number": "763-535-4288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES HOME CARE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-09",
        "last_updated": "2012-01-09",
        "status": "A",
        "authorized_official_last_name": "EGERE",
        "authorized_official_first_name": "MARY-KIM",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "763-537-6651",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": "MN",
            "license": "353271",
            "primary": true
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "MN",
            "license": "353271",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLASS A",
            "identifier": "353271",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PCPO",
            "identifier": "A838495100",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "A697120000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Nursing Care Agency in Crystal, MN
• Providers in Crystal, MN by specialty
• Nursing Care Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2012; 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.