Healthcare Provider Details

I. General information

NPI: 1760606495
Provider Name (Legal Business Name): COMMUNITY ASSISTANCE PROGRAM AND SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 LANSING AVENUE
JACKSON MI
49202-3215
US

IV. Provider business mailing address

933 LANSING AVENUE
JACKSON MI
49202-3215
US

V. Phone/Fax

Practice location:
  • Phone: 517-788-6840
  • Fax:
Mailing address:
  • Phone: 517-788-6840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number6802080674
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number6802080674
License Number StateMI

VIII. Authorized Official

Name: KONNIE HANSEN
Title or Position: OWNER CASE MANAGER
Credential:
Phone: 517-788-6840