MEDICARE: COMPLETE CARE CONNECTIONS LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	224ZE0001X	Environmental Modification Occupational Therapy Assistant
2	225XE0001X	Environmental Modification Occupational Therapist
3	225XG0600X	Gerontology Occupational Therapist
4	225X00000X	Occupational Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215603808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPLETE CARE CONNECTIONS LLC

Provider Business Mailing Address
First Line	:	3504 DIAMOND SPRINGS DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-2481
Country	:	US
Telephone Number	:	336-624-2937
Fax Number	:

Provider Business Practice Location Address
First Line	:	3504 DIAMOND SPRINGS DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-2481
Country	:	US
Telephone Number	:	336-624-2937
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JOLEEN ANTONIA ANDREWS
Credential	:	OT/L
Telephone Number	:	336-624-2937

Provider Enumeration Date	:	08/23/2021
Last Update Date	:	04/06/2022

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Directions to “COMPLETE CARE CONNECTIONS LLC ” Practice Location

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