Healthcare Provider Details

I. General information

NPI: 1124266499
Provider Name (Legal Business Name): CARECONNECT HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2009
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 E 16TH AVE
CORDELE GA
31015-1513
US

IV. Provider business mailing address

P.O. BOX 5610
CORDELE GA
31010-1514
US

V. Phone/Fax

Practice location:
  • Phone: 229-271-9330
  • Fax: 229-271-9245
Mailing address:
  • Phone: 229-273-8881
  • Fax: 229-273-8985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: LINDA YOUNG
Title or Position: SECRETARY
Credential:
Phone: 229-273-8881