Healthcare Provider Details

I. General information

NPI: 1417879693
Provider Name (Legal Business Name): COMMUNITY CONNECT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 LAKE PLAZA DR STE A111
INDIANAPOLIS IN
46220-4069
US

IV. Provider business mailing address

6801 LAKE PLAZA DR STE A111
INDIANAPOLIS IN
46220-4069
US

V. Phone/Fax

Practice location:
  • Phone: 317-529-9155
  • Fax: 317-529-9155
Mailing address:
  • Phone: 317-529-9155
  • Fax: 317-529-9155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: SHERRI ELAINE CAMPBELL
Title or Position: OWNER/OPERATOR
Credential: CLINICAL SOCIAL WORK
Phone: 317-529-9155