MEDICARE: C3 TRANSITIONING INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261Q00000X	Clinic/Center
2	261QH0100X	Health Service Clinic/Center
3	261QV0200X	VA Clinic/Center
4	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
5	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1821443441
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C3 TRANSITIONING INC

Provider Business Mailing Address
First Line	:	7151 MARTIN RD
Second Line	:
City	:	IMLAY CITY
State	:	MI
Zip	:	48444-9303
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7151 MARTIN RD
Second Line	:
City	:	IMLAY CITY
State	:	MI
Zip	:	48444-9303
Country	:	US
Telephone Number	:	248-904-2377
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	LYDIA L WILLIS
Credential	:
Telephone Number	:	248-904-2377

Provider Enumeration Date	:	05/02/2016
Last Update Date	:	05/07/2016

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