Healthcare Provider Details

I. General information

NPI: 1215603808
Provider Name (Legal Business Name): COMPLETE CARE CONNECTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2021
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3504 DIAMOND SPRINGS DR
RALEIGH NC
27610-2481
US

IV. Provider business mailing address

3504 DIAMOND SPRINGS DR
RALEIGH NC
27610-2481
US

V. Phone/Fax

Practice location:
  • Phone: 336-624-2937
  • Fax:
Mailing address:
  • Phone: 336-624-2937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224ZE0001X
TaxonomyEnvironmental Modification Occupational Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XE0001X
TaxonomyEnvironmental Modification Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: JOLEEN ANTONIA ANDREWS
Title or Position: CEO
Credential: OT/L
Phone: 336-624-2937