NPIMap

Organization Active NPI

Great Lakes Home Healthcare Specialists, LLC

  • Home Health Agency
  • Traverse City, MI
National Provider Identifier
1417374075
Registry record updated Jan 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
GREAT LAKES HOME HEALTHCARE SPECIALISTS, LLC
Practice address
3281 Racquet Club Dr Unit a
Traverse City, MI 49684-4701
Phone
(231) 421-5036
NPI assigned
Mar 20, 2014
Last updated
Jan 9, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2024

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

Authorized official

Name
James A Harvey, MSPTNPI 1043367071
Title
President
Phone
(231) 421-5036

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

3281 Racquet Club Dr Unit a
Traverse City, MI 49684-4701

Mailing address

3529 Brayton LN
Traverse City, MI 49685-7444
Phone (123) 164-2616

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140812001538 MI Part A Provider - Home Health Agency 1557588746 Practice locations: Traverse City, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1417374075. Details of each certification follow.

Home health agency certification: CCN 239304

Legal name
GREAT LAKES HOME HEALTHCARE SPECIALISTS, LLC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Mar 23, 2015
Last certification
Mar 29, 2018
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Incorporated
Feb 12, 2014 in MI
Enrollment address
3281 Racquet Club Dr
Suite a
Traverse City, MI 49684-4701
HHA Branch

Care Compare: Home health agency

Medicare Care Compare
Listed as
Great Lakes Home Healthcare Specialists LLCCCN 239304 · All quality measures
Overall star rating
3 of 5
Ownership
Proprietary
Certified
Mar 23, 2015
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D2087093Great Lakes Home Healthcare Specialist3281 Racquet Club Drive Suite a, Traverse City, MI 49684Certificate of waiverNov 17, 2026

National Provider Directory

National Provider Directory

Locations

1650 Barlow St
#10
Traverse City, MI 49686
Phone 23142150361

Ownership & related parties

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
James a Harvey Individual 5% Or Greater Direct Ownership Interest Feb 12, 2014 100%
Corporate OfficerCeo Feb 12, 2014
Corporate DirectorBoard Member Feb 12, 2014
W-2 Managing EmployeeAdministrator Feb 12, 2014

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.

Affiliated clinicians 10

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1395273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704758400000",
    "number": "1417374075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3529 BRAYTON LN",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496857444",
            "telephone_number": "123-164-2616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3281 RACQUET CLUB DR UNIT A",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496844701",
            "telephone_number": "231-421-5036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES HOME HEALTHCARE SPECIALISTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-20",
        "last_updated": "2024-01-09",
        "certification_date": "2024-01-09",
        "status": "A",
        "authorized_official_last_name": "HARVEY",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "231-421-5036",
        "authorized_official_credential": "MSPT"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Traverse City, MI

Sources for this page

Verify at the official NPI Registry.