MEDICARE: CONNECTING COMMUNITY HEALTHCARE

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1588117972
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONNECTING COMMUNITY HEALTHCARE

Provider Business Mailing Address
First Line	:	8621 SANDY PLAINS DR
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33578-8617
Country	:	US
Telephone Number	:	813-892-7811
Fax Number	:

Provider Business Practice Location Address
First Line	:	8621 SANDY PLAINS DR
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33578-8617
Country	:	US
Telephone Number	:	813-892-7811
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	OLIVIA ANDERSON
Credential	:
Telephone Number	:	813-892-7811

Provider Enumeration Date	:	08/02/2016
Last Update Date	:	08/02/2016

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