NPIMap

Organization Active NPI

Great Lakes Behavior Management Specialists, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Granger, IN
National Provider Identifier
1891346441
Registry record updated Sep 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
GREAT LAKES BEHAVIOR MANAGEMENT SPECIALISTS, INC.
Practice address
6910 N Main St Unit 13
Granger, IN 46530-9681
Phone
(574) 231-6766
Fax
(833) 249-2411
NPI assigned
Sep 25, 2019
Last updated
Sep 25, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2019

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

Authorized official

Name
David M Groff
Title
President
Phone
(574) 231-6766

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU Primary

Addresses

Primary practice location

6910 N Main St Unit 13
Granger, IN 46530-9681

Mailing address

52021 Cloverleaf Dr W
South Bend, IN 46637-6034
Phone (574) 274-5173

Other names 1

  • Great Lakes Behavior Management Specialists, Inc. Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200515001270 IN Part B Supplier - Clinic/Group Practice 9436580958 Receives reassigned benefits from 9 practitioners
Practice locations: Granger, IN

National Provider Directory

National Provider Directory

Locations

1721 Greencroft Blvd
Goshen, IN 46526
Phone (574) 831-6598

6910 N Main St
Unit 13
Granger, IN 46530
Phone (574) 216-1686

6910 N Main St
Unit 52
Granger, IN 46530
Phone (574) 231-6766

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1569369600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1569369600000",
    "number": "1891346441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "52021 CLOVERLEAF DR W",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466376034",
            "telephone_number": "574-274-5173",
            "fax_number": "833-249-2411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6910 N MAIN ST UNIT 13",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "465309681",
            "telephone_number": "574-231-6766",
            "fax_number": "833-249-2411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES BEHAVIOR MANAGEMENT SPECIALISTS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-25",
        "last_updated": "2019-09-25",
        "status": "A",
        "authorized_official_last_name": "GROFF",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "574-231-6766"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Great Lakes Behavior Management Specialists, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Granger, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.