Healthcare Provider Details

I. General information

NPI: 1679931786
Provider Name (Legal Business Name): ECD CONNECTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2016
Last Update Date: 02/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 CUB CT
EFFORT PA
18330-8035
US

IV. Provider business mailing address

PO BOX 961
EFFORT PA
18330-0961
US

V. Phone/Fax

Practice location:
  • Phone: 570-656-4047
  • Fax: 888-204-7845
Mailing address:
  • Phone: 570-656-4047
  • Fax: 888-204-7845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: MICHELE MANN
Title or Position: AGENCY SUPERVISOR/OWNER
Credential:
Phone: 570-656-4047