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4287 Five Oaks Dr Lansing MI 48911-4214 | |
| (517) 882-4000 | |
| (517) 882-3506 |
| Full Name | |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 4287 Five Oaks Dr, Lansing, Michigan |
| Authorized Official Name and Position | Julie Thomasma (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 5178824000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
4287 Five Oaks Dr Lansing MI 48911-4214 Ph: (517) 882-4000 | 4287 Five Oaks Dr Lansing MI 48911-4214 Ph: (517) 882-4000 |
| NPI Number | 1679594832 |
|---|---|
| Provider Enumeration Date | 07/22/2006 |
| Last Update Date | 05/13/2024 |
| Certification Date | 05/13/2024 |
| Medicare PECOS PAC ID | 1052847597 |
|---|---|
| Medicare Enrollment ID | O20241209000341 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679594832 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| 251V00000X | Voluntary Or Charitable | (* (Not Available)) | Secondary |
| Provider Name | Andrea J Calabrese |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902192271 PECOS PAC ID: 3870029317 Enrollment ID: I20241209000458 |
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