NPI 1023146792

Community Care Services

Organisation Exclusive Provider Organization Lincoln Park, MI

Practice location

Address: 1736 Fort St, Lincoln Park, MI 48146-1904
Phone: (313) 382-7861
Mailing address: 28541 Spruce Dr, Flat Rock, MI 48134-9772

Authorised official

Name: Raymond Kyle Bayne
Title: Mental Health Therapist III
Phone: (313) 382-7861

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X

Other Exclusive Provider Organization providers in Michigan →

Registry record

NPI: 1023146792
Entity type: Organization
NPI issued: 2 Mar 2007
Record last updated: 30 Aug 2011

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.