GREAT LAKES BEHAVIOR MANAGEMENT SPECIALISTS, INC. (NPI# 1891346441) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891346441 |
| Entity Type | Organization |
| Organization Name | GREAT LAKES BEHAVIOR MANAGEMENT SPECIALISTS, INC. |
| Practice Address |
6910 N Main St Unit 13 Granger IN 46530-9681 |
| Mailing Address |
52021 Cloverleaf Dr W South Bend IN 46637-6034 |
| Practice Telephone | 5742316766 |
| Practice Fax Number | 8332492411 |
| Mailing Telephone | 5742745173 |
| Mailing Fax Number | 8332492411 |
| Enumeration Date | 2019-09-25 |
| Last Update Date | 2019-09-25 |
| Authorized Official Name | DAVID M GROFF (PRESIDENT) |
| Authorized Official Telephone | 5742316766 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Great Lakes Behavior Management Specialists, Inc. | Former Legal Business Name - Organization |
| Street Address |
6910 N MAIN ST UNIT 13 |
| City | GRANGER |
| State | IN |
| Zip Code | 46530-9681 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821610783 | Michiana Weight Loss and Wellness Clinic LLC | Internal Medicine | 14304 Sr 23, Granger, IN 46530 | 2020-05-14 |
| 1609427921 | Stephen J Armet | Physical Therapist | 16733 Saratoga Ct, Granger, IN 46530 | 2019-09-27 |
| 1881177756 | Memorial Hospital of South Bend | General Acute Care Hospital | 3220 Beacon Parkway, Granger, IN 46530 | 2018-09-07 |
| 1922483635 | Kiley Ramer | Behavioral Analyst | 6910 N Main St Bldg 13c51, Granger, IN 46530 | 2015-07-23 |
| 1326439415 | Costco Wholesale Corporation | Eyewear Supplier (Equipment, not the service) | 625 E University Dr., Granger, IN 46530 | 2015-02-10 |
| 1811302094 | Costco Wholesale Corporation | Pharmacy | 625 E. University Drive, Granger, IN 46530 | 2014-06-25 |
| 1255773255 | Tracy Joyce Abel | Behavioral Analyst | 12042 Covered Wagon Court, Granger, IN 46530 | 2013-07-19 |
| 1225376304 | George Youssef | Internal Medicine | 5610 Town Center Drive #14, Granger, IN 46530 | 2013-01-23 |
| 1033489596 | Rene Raul Arce Guarnaluse | Homeopath | Emilio Bayarri 50, Puzol, VALENCIA 46530 | 2011-12-30 |
| 1568747368 | Ranya Bouzou-kadi | Pharmacist | 13060 Adams, Granger, IN 46530 | 2011-10-13 |
| Find all providers in zip 46530 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
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|---|---|---|---|---|
| 1689154742 | Marcia Koelndorfer Counseling, LLC | Clinic/Center | 14887 State Road 23 Ste 3, Granger, IN 46530-5629 | 2018-08-17 |
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| 1326658568 | Jennifer Steinmetz Msw LLC | Clinic/Center | 115 N College Ave Ste 225, Bloomington, IN 47404-4099 | 2020-08-03 |
| 1376161810 | North Clark Behavioral Health LLC | Clinic/Center | 2100 Market St Ste 200, Charlestown, IN 47111-8507 | 2020-07-10 |
| 1265068084 | Wellness Etc LLC | Clinic/Center | 1133 W Mill Rd Ste 200, Evansville, IN 47710-3877 | 2020-03-13 |
| 1114553948 | Johnson Nichols Health Clinic, Inc. | Clinic/Center | 720 N Marr Rd Ste A, Columbus, IN 47201-6660 | 2020-03-12 |
| 1376174904 | Karen Brosius LLC | Clinic/Center | 901 S Rogers St Ste 201, Bloomington, IN 47403-4760 | 2020-02-02 |
| 1396385886 | Urban Act Academy | Clinic/Center | 1250 E Market St, Indianapolis, IN 46202-3831 | 2020-01-13 |
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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.