Provider Demographics
NPI:1114796281
Name:LANSING SENIOR PARTNERS LLC
Entity Type:Organization
Organization Name:LANSING SENIOR PARTNERS LLC
Other - Org Name:BRIGHTWELL BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REVENUE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:BEHAVIORAL
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-804-2526
Mailing Address - Street 1:PO BOX 30516
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48909-8016
Mailing Address - Country:US
Mailing Address - Phone:517-318-5889
Mailing Address - Fax:517-318-5915
Practice Address - Street 1:3512 COOLIDGE RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-6376
Practice Address - Country:US
Practice Address - Phone:517-318-5889
Practice Address - Fax:517-318-5915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-29
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health