Copper Country Community Mental Health Services
Organization Active NPI Community/Behavioral Health Agency · Lanse, MI
NPI 1205023652 · NPPES record last updated Oct 1, 2007
Key facts
- NPI
- 1205023652
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Behavioral Health Agency 251S00000X
- Legal business name
- COPPER COUNTRY COMMUNITY MENTAL HEALTH SERVICES
- Practice address
- 15644 Skanee Rd
Lanse, MI 49946-9003 - Phone
- (906) 524-5885
- Fax
- (906) 483-0269
- NPI assigned
- Oct 1, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. Lawrence J. Pollack, PHD.
- Title
- Executive Director
- Phone
- (906) 482-9400
Other NPIs on the same Medicare enrollment 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20081211000294 | MI | Part B Supplier - Clinic/Group Practice | 8426119256 |
Receives reassigned benefits from 20 practitioners 3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Ontonagon, MI; Houghton, MI; Calumet, MI; Lanse, MI |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | Yes |
Addresses
Primary practice location
15644 Skanee Rd
Lanse, MI 49946-9003
Mailing address
901 W. Memorial Dr.
Houghton, MI 49931
Phone (906) 482-9400
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1707962 | Medicaid | MI | |
| 10603 | Other | BLUE CROSS BLUE SHIELD MI |
Other providers in Lanse, MI
- Ronald James Carmody
- Amy Elizabeth Carter
- Daniel Patrick Cavanaugh
- Sharon Gilliland Cheek
- Pooja Chhabra
- County of Houghton
- County of Houghton
- Cherie Cardinelle Dakota
- Daniel Cavanaugh Chiropractic PLLC
- Courtney Ann Darcy
All providers in Lanse, MI · Community/Behavioral Health Agency in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 1, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.