Healthcare Provider Details

I. General information

NPI: 1992240667
Provider Name (Legal Business Name): CPR CONNECTION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2017
Last Update Date: 01/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

752 N MAIN ST UNIT 1880
MANSFIELD TX
76063-3644
US

IV. Provider business mailing address

752 N MAIN ST UNIT 1880
MANSFIELD TX
76063-3644
US

V. Phone/Fax

Practice location:
  • Phone: 188-869-7167
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: ISATOU JAWARA
Title or Position: ADMINISTRATOR
Credential:
Phone: 18886971672