Healthcare Provider Details

I. General information

NPI: 1962338434
Provider Name (Legal Business Name): CONNECTED COMMUNITY CARE WNY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 NIAGARA ST
NIAGARA FALLS NY
14303-1365
US

IV. Provider business mailing address

11 UNION ST S STE 310
CONCORD NC
28025-5073
US

V. Phone/Fax

Practice location:
  • Phone: 704-890-5260
  • Fax:
Mailing address:
  • Phone: 704-890-5260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ANITA BROWN
Title or Position: DIRECTOR
Credential:
Phone: 704-890-5260