MEDICARE: CONNECTIONS COMMUNITY SUPPORT PROGRAMS INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1033722046
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONNECTIONS COMMUNITY SUPPORT PROGRAMS INC.

Provider Business Mailing Address
First Line	:	3821 LANCASTER PIKE
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19805-1512
Country	:	US
Telephone Number	:	302-377-2358
Fax Number	:	302-984-3385

Provider Business Practice Location Address
First Line	:	706 PORT PENN RD
Second Line	:
City	:	MIDDLETOWN
State	:	DE
Zip	:	19709-8926
Country	:	US
Telephone Number	:	833-886-2277
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	JEVON Z HICKS
Credential	:
Telephone Number	:	302-377-2358

Provider Enumeration Date	:	08/28/2020
Last Update Date	:	08/28/2020

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