Healthcare Provider Details

I. General information

NPI: 1578582672
Provider Name (Legal Business Name): CCS/LANSING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W TOWNSEND RD
SAINT JOHNS MI
48879-9200
US

IV. Provider business mailing address

101 W TOWNSEND RD
SAINT JOHNS MI
48879-9200
US

V. Phone/Fax

Practice location:
  • Phone: 989-224-1177
  • Fax: 989-224-7078
Mailing address:
  • Phone: 989-224-1177
  • Fax: 989-224-7078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number StateMI

VIII. Authorized Official

Name: DIANA YOUNT
Title or Position: ADMINISTRATOR
Credential:
Phone: 989-224-1177