Healthcare Provider Details

I. General information

NPI: 1760012587
Provider Name (Legal Business Name): CLINTON COUNTY COMMUNITY CONNECTIONS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2020
Last Update Date: 01/21/2020
Certification Date: 01/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 N WASHINGTON STREET
LOCK HAVEN PA
17745
US

IV. Provider business mailing address

10 N WASHINGTON STREET
LOCK HAVEN PA
17745
US

V. Phone/Fax

Practice location:
  • Phone: 570-748-9006
  • Fax: 570-858-1037
Mailing address:
  • Phone: 570-748-9006
  • Fax: 570-858-1037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SCOTT MOORE
Title or Position: CEO
Credential:
Phone: 570-748-9006