Great Lakes Senior Care, LLC

Primary specialty

Physical Disabilities Residential Treatment FacilityTaxonomy code 320700000X

License

110126101 Issued in IN

Legal business name

GREAT LAKES SENIOR CARE, LLC

Doing business as

Home Helpers

Practice address

6040 Lute Rd
Portage, IN 46368-5008

Phone

(219) 841-7559

Fax

(219) 763-4858

NPI assigned

Oct 11, 2011

Organization subpart

No

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

Authorized official

Name

Mr. James R Vanvliet

Title

Managing Partner

Phone

(219) 841-7559

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Home Helpers Doing business as

Locations

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

{
    "created_epoch": "1318291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318291200000",
    "number": "1376828228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6040 LUTE RD",
            "city": "PORTAGE",
            "state": "IN",
            "postal_code": "463685008",
            "telephone_number": "219-841-7559",
            "fax_number": "219-763-4858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6040 LUTE RD",
            "city": "PORTAGE",
            "state": "IN",
            "postal_code": "463685008",
            "telephone_number": "219-841-7559",
            "fax_number": "219-763-4858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES SENIOR CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-11",
        "last_updated": "2011-10-11",
        "status": "A",
        "authorized_official_last_name": "VANVLIET",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "219-841-7559",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320700000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Physical Disabilities",
            "state": "IN",
            "license": "110126101",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2010300000 A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Home Helpers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gabrielle Gonzalez, MS, BCBA
• Meghan Goranson, PTA
• Cimone Lynae Gordon
• Lisa Gorski
• Roshanda Grayson-Thomas, APRN
• Greater Lakes Behavioral Health Services LLC
• L. Allen Grecula
• Darcie A Gresham, OTR
• Stephanie L. Grider, DMD
• Margaret Eileen Griffith, DDS

• Physical Disabilities Residential Treatment Facility in Portage, IN
• Providers in Portage, IN by specialty
• Physical Disabilities Residential Treatment Facility in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2011; 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.