Great Lakes Dialysis, L.L.C.

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

License

4301072901 Issued in MI

Legal business name

GREAT LAKES DIALYSIS, L.L.C.

Practice address

14614 Kercheval St
Detroit, MI 48215-2814

Phone

(313) 308-4200

Fax

(313) 332-0334

NPI assigned

Aug 2, 2006

Organization subpart

No

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

Authorized official

Name

Morufu Olatunji Alausa, MD

Title

Authorized Official / Cmo

Phone

(815) 741-6830

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dialysis Care Center Great Lakes East Doing business as

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Listed as

Dialysis Care Center Great Lakes EastCCN 232614

Overall star rating

1.0 of 5

Ownership

Profit

Certified

Dec 17, 2003

Medicare certification status

ActiveFrom the Provider of Services file

Dialysis stations

24

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

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Boniface Atakekor Tubie, M.D.

  • Nephrology Physician
  • Southfield, MI
  • NPI 1821144577
  NPD (past)

Affiliated clinicians 1

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

• Boniface Atakekor Tubie, M.D.

  • Nephrology Physician
  • Southfield, MI
  • NPI 1821144577

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743984000000",
    "number": "1720095417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 428",
            "city": "LOCKPORT",
            "state": "IL",
            "postal_code": "604416428",
            "telephone_number": "815-714-7170",
            "fax_number": "630-672-4980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14614 KERCHEVAL ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482152814",
            "telephone_number": "313-308-4200",
            "fax_number": "313-332-0334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES DIALYSIS, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-02",
        "last_updated": "2025-04-07",
        "certification_date": "2025-04-07",
        "status": "A",
        "authorized_official_last_name": "ALAUSA",
        "authorized_official_first_name": "MORUFU",
        "authorized_official_middle_name": "OLATUNJI",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL / CMO",
        "authorized_official_telephone_number": "815-741-6830",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "MI",
            "license": "4301072901",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA#",
            "identifier": "23D1011980",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dialysis Care Center Great Lakes East",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Grayson'S One on One Care LLC
• Leah Grazes, APRN, NNP-DC
• Great American Rehabilitation and Physical Therapy Center, Inc.
• Great Futures Family Services Inc
• Great Lakes Accident Service LTD.
• Great Lakes Family Medical Center PLLC
• Great Lakes Family Medical Center PLLC
• Great Lakes Family Services
• Great Lakes Medical Supplies Inc
• Great Lakes Property & Investment, Inc

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Detroit, MI
• Providers in Detroit, MI by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.