Healthcare Provider Details

I. General information

NPI: 1356284269
Provider Name (Legal Business Name): MICHIGAN COMMUNITY CARE COLLABORATIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5303 S CEDAR ST
LANSING MI
48911-3800
US

IV. Provider business mailing address

5303 S CEDAR ST
LANSING MI
48911-3800
US

V. Phone/Fax

Practice location:
  • Phone: 231-739-5858
  • Fax:
Mailing address:
  • Phone: 231-739-5858
  • 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: MRS. PAM CURTIS
Title or Position: PRESIDENT
Credential: CURTIS
Phone: 231-739-5858