Healthcare Provider Details

I. General information

NPI: 1508594938
Provider Name (Legal Business Name): TRACY COMMUNITY CONNECTIONS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2022
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 W 11TH ST STE 206
TRACY CA
95376-3961
US

IV. Provider business mailing address

PO BOX 1215
TRACY CA
95378-1215
US

V. Phone/Fax

Practice location:
  • Phone: 209-407-9649
  • Fax:
Mailing address:
  • Phone: 209-407-9649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: CAROLINE GROVER
Title or Position: CEO
Credential:
Phone: 209-407-9649