Healthcare Provider Details

I. General information

NPI: 1417109026
Provider Name (Legal Business Name): COMMUNITY CONNECTIONS PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2008
Last Update Date: 10/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 CLEVELAND AVE N SUITE 101
SAINT PAUL MN
55104-5031
US

IV. Provider business mailing address

475 CLEVELAND AVE N SUITE 101
SAINT PAUL MN
55104-5031
US

V. Phone/Fax

Practice location:
  • Phone: 651-646-2400
  • Fax: 651-646-8024
Mailing address:
  • Phone: 651-646-2400
  • Fax: 651-646-8024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. APRIL BAUER
Title or Position: FINANCE ADMINISTRATOR
Credential:
Phone: 651-646-2400