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NPI Code Detail

MEDICARE: VICTORY CLINICAL SERVICES LANSING

MEDICARE: VICTORY CLINICAL SERVICES LANSING
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0850XAdult Mental Health Clinic/Center330330MI
2261QM2800XMethadone Clinic330330MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MI 10046MOTHERMIOTP - SAMHSA #

General Provider Information

NPI Number : 1861627507
Entity Type Code : Organization
Provider Name (Legal Business Name) : VICTORY CLINICAL SERVICES LANSING
Provider Business Mailing Address
First Line : 4902 S CEDAR ST
Second Line :
City : LANSING
State : MI
Zip : 48910-5474
Country : US
Telephone Number : 517-394-7867
Fax Number : 517-394-7869
Provider Business Practice Location Address
First Line : 4902 S CEDAR ST
Second Line :
City : LANSING
State : MI
Zip : 48910-5474
Country : US
Telephone Number : 517-394-7867
Fax Number : 517-394-7869
Authorized Official
Title or Position : PROGRAM DIRECTOR
Name : MR. DAVID BLANKENSHIP
Credential :
Telephone Number : 517-394-7867
Provider Enumeration Date : 05/26/2009
Last Update Date : 03/22/2012

Similar Medicare Providers

1891725214 — DENISE MARIE WARREN DO
Practice Location Address:
4902 S CEDAR ST
LANSING, MI
48910-5474
Practice Phone: 517-394-7869
Practice Fax:
1700104460 — MR. MICHAEL FRANCIS LAGROU
Practice Location Address:
4902 S CEDAR ST
LANSING, MI
48910-5474
Practice Phone: 517-394-7867
Practice Fax:
1699096941 — EVA BEAUCHEMIN LLMSW
Practice Location Address:
4902 S CEDAR ST
LANSING, MI
48910-5474
Practice Phone: 517-394-7867
Practice Fax: 517-394-7867
1295032738 — KEVIN MATTHEW BUCCI B.A.
Practice Location Address:
4902 S CEDAR ST
LANSING, MI
48910-5474
Practice Phone: 517-394-7867
Practice Fax:
1952676181 — MRS. TINA MARIE SIMS LMSW CAADC BSW
Practice Location Address:
4902 S CEDAR ST
LANSING, MI
48910-5474
Practice Phone: 517-394-7867
Practice Fax: 517-394-7867
1487902508 — MS. ERIN LEIGH HAGER LLMSW
Practice Location Address:
4902 S CEDAR ST
LANSING, MI
48910-5474
Practice Phone: 517-394-7867
Practice Fax:

Directions to “VICTORY CLINICAL SERVICES LANSING ” Practice Location

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