MEDICARE: COMMUNITY CONNECTIONS ISS SERVICES 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	251S00000X	Community/Behavioral Health Agency
2	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1093500894
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY CONNECTIONS ISS SERVICES LLC

Provider Business Mailing Address
First Line	:	4357 RITTIMAN RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78218-4362
Country	:	US
Telephone Number	:	210-409-5544
Fax Number	:

Provider Business Practice Location Address
First Line	:	4357 RITTIMAN RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78218-4362
Country	:	US
Telephone Number	:	210-409-5544
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TYCHELLE HILL
Credential	:
Telephone Number	:	210-409-5544

Provider Enumeration Date	:	04/11/2025
Last Update Date	:	04/11/2025

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