# CC'S VILLA LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235803081
- **Authorized official:** JOHNNY WELSH (OWNER)
- **Authorized official phone:** (810) 378-5550

## Contact information

- **Practice address:** 41 W LORRAINE ST, PECK, MI 48466-9619
- **Practice address phone:** (810) 378-5550
- **Mailing address:** 41 W LORRAINE ST, PECK, MI 48466-9619
- **Mailing address phone:** (810) 378-5550

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 08/05/2021
- **Last updated:** 08/05/2021