Healthcare Provider Details

I. General information

NPI: 1760955736
Provider Name (Legal Business Name): GERIATRIC CONNECTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2019
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7085 TERRITORIAL RD
BENTON HARBOR MI
49022-9458
US

IV. Provider business mailing address

7085 TERRITORIAL RD
BENTON HARBOR MI
49022-9458
US

V. Phone/Fax

Practice location:
  • Phone: 269-240-8042
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JULIE WECKEL
Title or Position: OWNER
Credential:
Phone: 269-240-8042