GREAT LAKES ADDICTION RECOVERY SERVICES PLLC (NPI# 1568084333) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568084333 |
| Entity Type | Organization |
| Organization Name | GREAT LAKES ADDICTION RECOVERY SERVICES PLLC |
| Practice Address |
142 E Maumee St Adrian MI 49221-2735 |
| Practice Telephone | 5173062244 |
| Practice Fax Number | 8664650269 |
| Mailing Telephone | 5173062244 |
| Mailing Fax Number | 8664650269 |
| Enumeration Date | 2020-05-14 |
| Last Update Date | 2020-05-14 |
| Authorized Official Name | ROBYN M JONES (BUSINESS MANAGER) |
| Authorized Official Telephone | 5173062244 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207QA0401X |
Family Medicine Specialization: Addiction Medicine |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 104719902 | 05 |
| Street Address |
142 E MAUMEE ST |
| City | ADRIAN |
| State | MI |
| Zip Code | 49221-2735 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174585475 | Theethaye Lonappan Ittiara | Psychiatry & Neurology | 142 E Maumee St, Adrian, MI 49221-2735 | 2006-04-04 |
| 1972053809 | Positive Solutions Counseling | Community/Behavioral Health | 142 E Maumee St, Ste 7, Adrian, MI 49221-2735 | 2016-10-04 |
| 1073886248 | Greg Michael Johnson | Psychologist | 142 E Maumee St, Adrian, MI 49221-2735 | 2012-02-17 |
| 1962700542 | Dora A Woodworth | Social Worker | 142 E Maumee St, Suite 3, Adrian, MI 49221-2735 | 2011-03-07 |
| 1205098704 | Joann M. Cubberly | Counselor | 142 E Maumee St, Suite 1, Adrian, MI 49221-2735 | 2008-06-26 |
| 1124289806 | Theethaye L. Ittiara, M.d., P.C. | Community/Behavioral Health | 142 E Maumee St, Adrian, MI 49221-2735 | 2008-06-24 |
| 1669647293 | Family Service & Children's Aid | Community/Behavioral Health | 142 E Maumee St, Suite 1, Adrian, MI 49221-2735 | 2008-04-24 |
| 1801066758 | Mark Allen Hall | Counselor | 142 E Maumee St, Suite 1, Adrian, MI 49221-2735 | 2008-03-06 |
| 1083820872 | Cortez and Associates | Social Worker | 142 E Maumee St, Suite 3, Adrian, MI 49221-2735 | 2007-05-16 |
| 1831212042 | Judith Ann Seigneur | Counselor | 142 E Maumee St, Adrian, MI 49221-2735 | 2007-04-10 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285116723 | Sandra Ann Harsh | Occupational Therapist | Total Rehab, 1136 Country Club, Adrian, MI 49221 | 2018-08-31 |
| 1588156178 | Chelsea Varney | Social Worker | 1040 Winter Street, Adrian, MI 49221 | 2018-05-31 |
| 1669974127 | Nicoletta Mary Bruno | Physical Therapy Assistant | 700 Lakeshire Trail, Adrian, MI 49221 | 2018-03-01 |
| 1871011403 | Evan Splan | Pharmacist | 1200 South Main St Suite A, Adrian, MI 49221 | 2017-09-04 |
| 1780104992 | Daniel Malcolm | Specialist/Technologist | 1325 Williams St., Adrian, MI 49221 | 2017-06-20 |
| 1639602881 | Robert Gargol | Pharmacist | 1535 W Maumee, Adrian, MI 49221 | 2017-04-05 |
| 1487196416 | Painless Dentistry V | Dentist | 160 N. Winter St., Adrian, MI 49221 | 2016-11-08 |
| 1487025227 | Michelle Lynn Ranta | Speech-Language Pathologist | 730 Kimole Ln., Adrian, MI 49221 | 2015-10-19 |
| 1376929109 | James Hamblin | Technician, Other | 1100 South Main St. Lot 139, Adrian, MI 49221 | 2015-08-04 |
| 1316320039 | Shirley Goodlock | Community/Behavioral Health | 3091 E. Carleton Rd, Adrian, MI 49221 | 2015-06-30 |
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| Taxonomy Code | 207QA0401X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Addiction Medicine |
| A family medicine physician who specializes in the diagnosis and treatment of addictions. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) was, but is no longer issued by the American Osteopathic Board of Family Physicians. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740836444 | White Lake Urgent Care | Family Medicine | 9178 Highland Rd Ste 1a, White Lake, MI 48386-4619 | 2019-08-18 |
| 1669665154 | Daniel A. Schwarz | Family Medicine | 18444 W 10 Mile Rd, Suite 102, Southfield, MI 48075-2653 | 2007-08-20 |
| 1134335359 | Jerry Avrum Appel | Family Medicine | 1720 South Hill Blvd, Bloomfield Township, MI 48304-1135 | 2007-05-15 |
| 1417099417 | Bio-med Behavioral Healthcare, Inc. | Family Medicine | 31581 Gratiot Ave, Roseville, MI 48066-4528 | 2007-02-13 |
| 1457469330 | Eric N. Coffman | Family Medicine | 27550 Joy Rd, Livonia, MI 48150-4145 | 2006-08-29 |
| 1598703621 | Carl Woodrow Christensen | Family Medicine | 4870 W Clark Rd Ste 201, Ypsilanti, MI 48197-1104 | 2006-06-02 |
| 1265498059 | Mark Allen Menestrina | Family Medicine | 12851 E Grand River, Brighton Hospital, Brighton, MI 48116-8596 | 2006-04-21 |
| 1790745966 | Douglas Lawrence Marsh | Family Medicine | 18590 Allen Rd, Melvindale, MI 48122-1516 | 2006-03-23 |
| 1952377566 | Bruce Henry Baker | Family Medicine | 3210 Eagle Run Dr, Suite 200, Grand Rapids, MI 49525 | 2006-02-23 |
| 1689275026 | Lindsey Ruth Mitchell | Family Medicine | 28477 Hoover Rd, Warren, MI 48093-5400 | 2020-11-03 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.