Healthcare Provider Details

I. General information

NPI: 1801843206
Provider Name (Legal Business Name): COMMUNITY CONNECTION OF MINNESOTA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4014 PITT ST
DULUTH MN
55804-1956
US

IV. Provider business mailing address

4014 PITT STREET
DULUTH MN
55804-1956
US

V. Phone/Fax

Practice location:
  • Phone: 218-525-4126
  • Fax: 218-525-5862
Mailing address:
  • Phone: 218-525-4126
  • Fax: 218-525-5862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: SHARON MACK
Title or Position: CEO
Credential:
Phone: 218-525-4126