MEDICARE: CCS/LANSING, INC

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	323P00000X	Psychiatric Residential Treatment Facility		MI

General Provider Information

NPI Number	:	1578582672
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CCS/LANSING, INC

Provider Business Mailing Address
First Line	:	101 W TOWNSEND RD
Second Line	:
City	:	SAINT JOHNS
State	:	MI
Zip	:	48879-9200
Country	:	US
Telephone Number	:	989-224-1177
Fax Number	:	989-224-7078

Provider Business Practice Location Address
First Line	:	101 W TOWNSEND RD
Second Line	:
City	:	SAINT JOHNS
State	:	MI
Zip	:	48879-9200
Country	:	US
Telephone Number	:	989-224-1177
Fax Number	:	989-224-7078

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DIANA YOUNT
Credential	:
Telephone Number	:	989-224-1177

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	08/22/2020

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Directions to “CCS/LANSING, INC ” Practice Location

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