Provider Demographics
NPI:1265483457
Name:COMMUNITY MENTAL HEALTH AUTHORITY OF CLINTON EATON INGHAM COUNTIES
Entity Type:Organization
Organization Name:COMMUNITY MENTAL HEALTH AUTHORITY OF CLINTON EATON INGHAM COUNTIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:LURIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-346-8212
Mailing Address - Street 1:812 E JOLLY ROAD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-6821
Mailing Address - Country:US
Mailing Address - Phone:517-346-8119
Mailing Address - Fax:517-346-8291
Practice Address - Street 1:812 E JOLLY ROAD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-6821
Practice Address - Country:US
Practice Address - Phone:517-346-8200
Practice Address - Fax:517-346-8291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-13
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI21-1708001Medicaid
MI21-1708001Medicaid
MI0C36233Medicare PIN
MI0C36007Medicare PIN