Healthcare Provider Details

I. General information

NPI: 1205432598
Provider Name (Legal Business Name): CONNECTIONS COMMUNITY SUPPORT PROGRAMS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2020
Last Update Date: 01/25/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 EAST ST
HARRINGTON DE
19952-1320
US

IV. Provider business mailing address

3821 LANCASTER PIKE
WILMINGTON DE
19805-1512
US

V. Phone/Fax

Practice location:
  • Phone: 833-886-2277
  • Fax:
Mailing address:
  • Phone: 302-377-2358
  • Fax: 302-984-3385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JEVON Z HICKS
Title or Position: DIRECTOR
Credential:
Phone: 302-377-2358