Provider Demographics
NPI:1609844976
Name:COMMUNITY CARE SERVICES
Entity type:Organization
Organization Name:COMMUNITY CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:P
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:313-389-7525
Mailing Address - Street 1:26184 W OUTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48146
Mailing Address - Country:US
Mailing Address - Phone:313-389-7525
Mailing Address - Fax:313-389-7515
Practice Address - Street 1:26184 W OUTER DRIVE
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146
Practice Address - Country:US
Practice Address - Phone:313-389-7525
Practice Address - Fax:313-389-7515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QC1500X
MI820588261QR0405X
MI820521261QR0405X
MI820428261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Not Answered261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
6842OtherMIDWEST HEALTH PLAN
040397OtherVALUE OPTIONS
20710OtherBCBS
6322OtherCAPE HEALTH PLAN
6U4765OtherHEALTH ALLIANCE PLAN
P42560OtherBLUE CARE NETWORK
20709OtherBCBS
207711OtherBCBS
MI3119549Medicaid
MI3119549Medicaid