Healthcare Provider Details

I. General information

NPI: 1760925556
Provider Name (Legal Business Name): CONNECT CARE NETWORK INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2016
Last Update Date: 11/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19761 ANNOTT ST
DETROIT MI
48205-1603
US

IV. Provider business mailing address

19761 ANNOTT ST
DETROIT MI
48205-1603
US

V. Phone/Fax

Practice location:
  • Phone: 313-372-7126
  • Fax: 313-372-7126
Mailing address:
  • Phone: 313-372-7126
  • Fax: 313-372-7126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number StateMI

VIII. Authorized Official

Name: CHANTE RESPRESS
Title or Position: CERTIFIED NURSE TECHNICIAN
Credential:
Phone: 313-372-7126