Healthcare Provider Details

I. General information

NPI: 1043546807
Provider Name (Legal Business Name): COMMUNITY CONNECTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2009
Last Update Date: 10/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 COMMERCIAL ST
EMPORIA KS
66801-2989
US

IV. Provider business mailing address

1101 COMMERCIAL ST
EMPORIA KS
66801-2989
US

V. Phone/Fax

Practice location:
  • Phone: 620-340-0317
  • Fax: 620-343-3033
Mailing address:
  • Phone: 620-340-0317
  • Fax: 620-343-3033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberA056014
License Number StateKS

VIII. Authorized Official

Name: XAVIAR CHRISTOPHER ALEC STEAVENSON
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 620-340-0317