MEDICARE: ESSENTIAL 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	261QD1600X	Developmental Disabilities Clinic/Center

General Provider Information

NPI Number	:	1215500186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESSENTIAL CONNECTIONS LLC

Provider Business Mailing Address
First Line	:	859 GAIRLOCH LN
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34947-1341
Country	:	US
Telephone Number	:	772-828-6911
Fax Number	:

Provider Business Practice Location Address
First Line	:	859 GAIRLOCH LN
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34947-1341
Country	:	US
Telephone Number	:	772-828-6911
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SABRINA TROUTMAN
Credential	:
Telephone Number	:	772-828-6911

Provider Enumeration Date	:	07/20/2021
Last Update Date	:	07/20/2021

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Directions to “ESSENTIAL CONNECTIONS LLC ” Practice Location

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