MEDICARE: COMMUNITY CONNECTIONS, LLC

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	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1083019558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY CONNECTIONS, LLC

Provider Business Mailing Address
First Line	:	9208 N 83RD PL
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85258-1884
Country	:	US
Telephone Number	:	480-367-6423
Fax Number	:

Provider Business Practice Location Address
First Line	:	17604 N 39TH AVE
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-3104
Country	:	US
Telephone Number	:	602-509-5248
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	JOEL TEMPLE
Credential	:
Telephone Number	:	480-367-6423

Provider Enumeration Date	:	10/27/2014
Last Update Date	:	10/27/2014

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Directions to “COMMUNITY CONNECTIONS, LLC ” Practice Location

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