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GREAT LAKES RECOVERY MISSION, LLC
NPI 1184111528
Substance Abuse Rehabilitation Facility in Flint, MI

Active since April 20, 2018
504 N GRAND TRAVERSE ST, FLINT, MI 48503(586) 491-1057 Get Directions Write a Review

NPPES record last updated: December 9, 2021. Verified against the NPPES registry weekly; last sync: October 04, 2026.

Record update history: Dec 9, 2021, Apr 24, 2021, Apr 20, 2018 (3 updates tracked since 2018).

About Great Lakes Recovery Mission, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GREAT LAKES RECOVERY MISSION, LLC (NPI 1184111528) is a healthcare organization registered as a substance abuse rehabilitation facility in Flint, Michigan and active in the NPI registry since April 2018. The organization lists Joshua Bukoffsky, Chief Executive Officer, as its authorized official.

NPPES Registry Identity

NPI1184111528
Entity TypeOrganization
Primary Taxonomy324500000X
Legal Business NameGREAT LAKES RECOVERY MISSION, LLC
Location Address504 N GRAND TRAVERSE STFlint, MI 48503-2536
Mailing Address5099 W Farrand RdClio, MI 48420-8215 · (586) 491-1057
Phone(586) 491-1057
Organization SubpartNo
Authorized OfficialJoshua BukoffskyChief Executive Officer · (586) 491-1057
Enumeration DateApril 20, 2018
Last NPPES UpdateDecember 9, 20213 updates tracked since enumeration
NPPES CertifiedDecember 9, 2021
✔ NPI 1184111528 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtySubstance Abuse Rehabilitation FacilityResidential Treatment Facilities
Taxonomy Code324500000X
Definition
A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.
Also ListedClinic/Center · Rehabilitation, Substance Use DisorderTaxonomy 261QR0405X
504 N GRAND TRAVERSE ST, Flint, MI 48503
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Other Providers at the Same Location NPPES 15

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

GARY-CHRISTIAN RYAN HERWIG-TUCKER
Technician
504 N GRAND TRAVERSE ST
FLINT, MI 48503
Genesee County (810) 487-4295
MANUEL ANDREW RODRIGUEZ
Peer Specialist
504 N GRAND TRAVERSE ST
FLINT, MI 48503
Genesee County (586) 491-1057
LYDIA M HEINE
Counselor (Addiction (Substance Use Disorder))
504 N GRAND TRAVERSE ST
FLINT, MI 48503
Genesee County (586) 491-1057
JESSICA LEANN CLARK
Counselor (Addiction (Substance Use Disorder))
504 N GRAND TRAVERSE ST
FLINT, MI 48503
Genesee County (810) 487-4676
CHRISTOPHER BOWEN
Counselor (Addiction (Substance Use Disorder))
504 N GRAND TRAVERSE ST
FLINT, MI 48503
Genesee County (810) 487-4676
MR. TODD ERNEST FOWLER CPRC
Counselor (Addiction (Substance Use Disorder))
504 N GRAND TRAVERSE ST
FLINT, MI 48503
Genesee County (586) 491-1057
AMANDA QUINN
Counselor (Addiction (Substance Use Disorder))
504 N GRAND TRAVERSE ST
FLINT, MI 48503
Genesee County (810) 487-4676
KIAH SUE-ANN WATTERS
Counselor (Addiction (Substance Use Disorder))
504 N GRAND TRAVERSE ST
FLINT, MI 48503
Genesee County (810) 487-4676

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Great Lakes Recovery Mission, LLC's NPI number?

The NPI number for Great Lakes Recovery Mission, LLC is 1184111528. It was assigned to this organization in the NPPES registry on April 20, 2018.

Where is Great Lakes Recovery Mission, LLC located?

Great Lakes Recovery Mission, LLC is located at 504 N Grand Traverse St, Flint, MI 48503. The listed phone number is (586) 491-1057.

What is Great Lakes Recovery Mission, LLC's specialty?

The primary specialty registered for this NPI is Substance Abuse Rehabilitation Facility with taxonomy code 324500000X.

When was this NPI record last updated?

The NPPES record for Great Lakes Recovery Mission, LLC was last updated on December 9, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.