NPIMap

Organization Active NPI

Great Lakes Recovery Mission, LLC

  • Substance Abuse Rehabilitation Facility
  • Flint, MI
National Provider Identifier
1548069586
Registry record updated Mar 11, 2025
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
422 W 6TH Ave
Flint, MI 48503-1348
Phone
(810) 487-4676
NPI assigned
Mar 11, 2025
Organization subpart
Yes
Parent organization
GREAT LAKES RECOVERY MISSION, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 11, 2025

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

Authorized official

Name
Joshua Bukoffsky
Title
Ceo
Phone
(586) 491-1057

Specialties & licenses 1

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

Addresses

Primary practice location

422 W 6TH Ave
Flint, MI 48503-1348

Mailing address

5099 W Farrand Rd
Clio, MI 48420-8215
Phone (810) 487-4676

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.

NPI Registry JSON

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

{
    "created_epoch": "1741651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741651200000",
    "number": "1548069586",
    "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": "810-487-4676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "422 W 6TH AVE",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485031348",
            "telephone_number": "810-487-4676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES RECOVERY MISSION, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GREAT LAKES RECOVERY MISSION, LLC",
        "enumeration_date": "2025-03-11",
        "last_updated": "2025-03-11",
        "certification_date": "2025-03-11",
        "status": "A",
        "authorized_official_last_name": "BUKOFFSKY",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_title_or_position": "CEO",
        "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 Mar 11, 2025; 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.