Healthcare Provider Details

I. General information

NPI: 1689628190
Provider Name (Legal Business Name): CATHOLIC CHARITIES OF JACKSON, LENAWEE AND HILLSDALE COUNTIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 FRANCIS ST
JACKSON MI
49203-5052
US

IV. Provider business mailing address

3425 FRANCIS ST
JACKSON MI
49203-5052
US

V. Phone/Fax

Practice location:
  • Phone: 517-782-2511
  • Fax: 517-783-1986
Mailing address:
  • Phone: 517-263-2191
  • Fax: 517-264-6080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SUE LEWIS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 517-263-2191