GREAT LAKES RECOVERY CENTER LLC
NPI 1497376735
Substance Abuse Rehabilitation Facility in Fremont, OH

NPI Status: Active since April 28, 2020

Contact Information

2575 HAYES AVE
FREMONT, OH
ZIP 43420
Phone: (567) 280-9435

NPI Profile Information
Primary Taxonomy
Insurance Plans Accepted
Authorized Official
CLIA Information
NPI Validation
Other Providers Same Location
Frequently Asked Questions

Organization
Substance Abuse Rehabilitation Facility
Accepts Insurance
CLIA Number: 36D2192337
CLIA Cert. Type: Other - SUD IOP
CLIA Exp. Date: 09-08-2026

About GREAT LAKES RECOVERY CENTER LLC

This page provides the complete NPI Profile along with additional information for Great Lakes Recovery Center Llc, a provider established in Fremont, Ohio operating as a Substance Abuse Rehabilitation Facility. The healthcare provider is registered in the NPI registry with number 1497376735 assigned on April 2020. The practitioner's primary taxonomy code is 324500000X. The provider is registered as an organization and their NPI record was last updated one year ago. The authorized official of this NPI record is David Guardiola Lisw-s (Executive Director)

NPI: 1497376735
Provider Name: GREAT LAKES RECOVERY CENTER LLC
Entity Type: Organization
Location Address: 2575 HAYES AVE FREMONT, OH 43420
Location Phone: (567) 280-9435
Mailing Address: 441 N BROADWAY ST GREEN SPRINGS, OH 44836
Mailing Phone: (419) 269-7740
Is Sole Proprietor?: No
Is Organization Subpart?: No
Enumeration Date: 04-28-2020
Last Update Date: 03-21-2024
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Location Map

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification: Substance Abuse Rehabilitation Facility
Taxonomy Code: 324500000X
Type: Residential Treatment Facilities
Taxonomy Description: 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.

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

Ambetter from Meridian

Clear Silver - HMO
Elite Bronze - HMO
Elite Bronze + Vision + Adult Dental - HMO
Elite Gold - HMO
Elite Gold + Vision + Adult Dental - HMO
Everyday Bronze - HMO
Everyday Bronze + Vision + Adult Dental - HMO
Everyday Gold - HMO
Everyday Gold + Vision + Adult Dental - HMO
Focused Silver - HMO
Focused Silver + Vision + Adult Dental - HMO
Standard Expanded Bronze - HMO
Standard Expanded Bronze + Vision + Adult Dental - HMO
Standard Gold - HMO
Standard Gold + Vision + Adult Dental - HMO
Standard Silver - HMO
Standard Silver + Vision + Adult Dental - HMO

Ambetter Health

Choice Bronze HSA - HMO
Choice Bronze HSA + Vision + Adult Dental - HMO
Clear Gold - HMO
Clear Gold + Vision + Adult Dental - HMO
Clear Silver - HMO
Complete Gold - HMO
Complete Gold + Vision + Adult Dental - HMO
Complete Silver - HMO
Complete Silver + Vision + Adult Dental - HMO
Elite Gold - HMO
Elite Gold + Vision + Adult Dental - HMO
Everyday Bronze - HMO
Everyday Bronze + Vision + Adult Dental - HMO
Focused Silver - HMO
Focused Silver + Vision + Adult Dental - HMO
Standard Expanded Bronze - HMO
Standard Expanded Bronze + Vision + Adult Dental - HMO
Standard Gold - HMO
Standard Gold + Vision + Adult Dental - HMO
Standard Silver - HMO

Molina Healthcare

Bronze 10 - HMO
Bronze 8 - HMO
Bronze 9 - HMO
Gold 1 - HMO
Gold 1 with Adult Vision Services - HMO
Gold 8 - HMO
Silver 1 - HMO
Silver 1 with Adult Vision Services - HMO
Silver 12 with first 4 free PCP or MH visits - HMO
Silver 8 - HMO

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name: DAVID GUARDIOLA LISW-S
Authorized Official Title: EXECUTIVE DIRECTOR
Authorized Official Phone: (419) 680-0172

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:

CLIA Number: 36D2192337
Facility Type: Other - SUD IOP
Certificate Effective Date: September 09, 2024
Certificate Expiration Date: September 08, 2026
Laboratory Director: DAVID GUARDIOLA
Certificate Type: Certificate of Waiver
Certificate Type Description: This CLIA certificate is issued to Great Lakes Recovery Center Llc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

NPI Validation Check Digit Calculation

The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1	4	9	7	3	7	6	7	3	5
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2	4	18	7	6	7	12	7	6
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 4 + 1 + 8 + 7 + 6 + 7 + 1 + 2 + 7 + 6 + 24 = 75
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
80 - 75 = 5									5

The NPI number 1497376735 is valid because the calculated check digit 5 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location

The following 10 providers are registered at the same or nearby location.

DR. JOHN JOSEPH HIESTAND M.D.

Internal Medicine

2575 HAYES AVE
SUITE 1
FREMONT, OH
ZIP 43420

(419) 332-1551

View Profile

DR. HOWARD G. STIERWALT M.D.

Family Medicine

2575 HAYES AVE
SUITE 3
FREMONT, OH
ZIP 43420

(419) 332-7371

View Profile

JONATHAN F. DILLER, M.D., INC.

Family Medicine

2575 HAYES AVE
SUITE 4
FREMONT, OH
ZIP 43420

(419) 332-9978

View Profile

DAWN RENAE HUMPHREY

Counselor

(Addiction (Substance Use Disorder))