MEDICARE: COMMUNITY CARE SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	302F00000X	Exclusive Provider Organization

General Provider Information

NPI Number	:	1023146792
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY CARE SERVICES

Provider Business Mailing Address
First Line	:	28541 SPRUCE DR
Second Line	:
City	:	FLAT ROCK
State	:	MI
Zip	:	48134-9772
Country	:	US
Telephone Number	:	734-782-4453
Fax Number	:

Provider Business Practice Location Address
First Line	:	1736 FORT ST
Second Line	:
City	:	LINCOLN PARK
State	:	MI
Zip	:	48146-1904
Country	:	US
Telephone Number	:	313-382-7861
Fax Number	:

Authorized Official
Title or Position	:	MENTAL HEALTH THERAPIST III
Name	:	MR. RAYMOND KYLE BAYNE III
Credential	:	MED.
Telephone Number	:	313-382-7861

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	08/30/2011

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Directions to “COMMUNITY CARE SERVICES ” Practice Location

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