Healthcare Provider Details

I. General information

NPI: 1912659335
Provider Name (Legal Business Name): COMMUNITY CONNECTIONS FOR INDEPENDENT LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2022
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42490 GARFIELD RD STE 206
CLINTON TOWNSHIP MI
48038-4200
US

IV. Provider business mailing address

13335 15 MILE RD STE 244
STERLING HEIGHTS MI
48312-4210
US

V. Phone/Fax

Practice location:
  • Phone: 586-899-3145
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MICHELE GORSKI
Title or Position: PRESIDENT
Credential:
Phone: 586-899-3145