- Enrollment id
- O20050520001020
- Enrollment state
- MI
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1588642110
- Multiple npi flag
- N
- Ccn
- 237274
- Associate id
- 5395734677
- Organization name
- GREAT LAKES HOME HEALTH SERVICES INC
- Doing business as name
- ELARA CARING
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 209 E WASHINGTON AVE
- Address line 2
- STE 450
- City
- JACKSON
- State
- MI
- Zip code
- 492012399