Provider Demographics
NPI:1134565336
Name:COMMUNITY ADVANCEMENT PROJECT
Entity type:Organization
Organization Name:COMMUNITY ADVANCEMENT PROJECT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-BC, NP
Authorized Official - Phone:616-301-1020
Mailing Address - Street 1:4215 W PASADENA AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48504-2342
Mailing Address - Country:US
Mailing Address - Phone:616-301-1020
Mailing Address - Fax:
Practice Address - Street 1:4215 W PASADENA AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504-2342
Practice Address - Country:US
Practice Address - Phone:616-301-1020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-14
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251J00000X
MI4704237090363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
No251J00000XAgenciesNursing Care