| Great Lakes Hope Llc | |
|
2687 Odawa Trl Muskegon MI 49444-6739 | |
| (231) 670-7416 | |
| Not Available |
| Full Name | Great Lakes Hope Llc |
|---|---|
| Speciality | Social Worker |
| Location | 2687 Odawa Trl, Muskegon, Michigan |
| Authorized Official Name and Position | Jessica Elizabeth Bennett (MEMBER) |
| Authorized Official Contact | 2316707416 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Great Lakes Hope Llc 2687 Odawa Trl Muskegon MI 49444-6739 Ph: (231) 670-7416 | Great Lakes Hope Llc 2687 Odawa Trl Muskegon MI 49444-6739 Ph: (231) 670-7416 |
| NPI Number | 1275132441 |
|---|---|
| Provider Enumeration Date | 10/20/2020 |
| Last Update Date | 04/07/2021 |
| Certification Date | 04/07/2021 |
| Medicare PECOS PAC ID | 6507274198 |
|---|---|
| Medicare Enrollment ID | O20210420002460 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275132441 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Jessica E Bennett |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1306184684 PECOS PAC ID: 7618121948 Enrollment ID: I20130213000499 |
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