GREAT LAKES CARE LLC NPI 1639075880

NPI Information

  • NPI: 1639075880
  • Provider Name: GREAT LAKES CARE LLC
  • Classification: Custodial Care Facility - 311ZA0620X
  • Specialization: Adult Care Home
  • Entity Type: Organization
  • :
  • Address: 3091 N CASALOMA DR APT 225
    APPLETON, WI
    ZIP 54913
  • Phone: (207) 900-4164

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NPI Details

GREAT LAKES CARE LLC is an adult care home custodial care facility in Appleton, WI. The provider is a custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. GREAT LAKES CARE LLC NPI is 1639075880. The provider is registered as an organization entity type.
The provider .

The provider's business location address is:

3091 N CASALOMA DR APT 225
APPLETON, WI
ZIP 54913-066
Phone: (207) 900-4164

The provider's authorized official is Yves Mpundu .
The authorized official title is Authourised Representative and has the following contact phone number (207) 900-4164.

The enumeration date for this NPI number is 10/15/2026 and was last updated on 10/15/2026.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1310400000XAssisted Living FacilityNo
2311ZA0620XCustodial Care FacilityAdult Care HomeYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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