Healthcare Provider Details

I. General information

NPI: 1487329454
Provider Name (Legal Business Name): COMMUNITY CASE MANAGEMENT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2021
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4315 W NEWBURG RD
CARLETON MI
48117-9164
US

IV. Provider business mailing address

4315 W NEWBURG RD
CARLETON MI
48117-9164
US

V. Phone/Fax

Practice location:
  • Phone: 734-770-8676
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: TAMMY FIELDS
Title or Position: OWNER
Credential:
Phone: 734-770-8676