Provider Demographics
NPI:1467703165
Name:SANTOS, YOLANDA
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:
Last Name:SANTOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CANNELLE
Other - Middle Name:
Other - Last Name:SANTOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4352 DELL RD APT J
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-8141
Mailing Address - Country:US
Mailing Address - Phone:815-508-6197
Mailing Address - Fax:
Practice Address - Street 1:3285 W STOLL RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48906-9357
Practice Address - Country:US
Practice Address - Phone:517-507-4855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities