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General NPI Number Information
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NPI Number | 1043596109
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Entity Type | Organization
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Legal Business Name | COMMUNITY CONNECTIONS, INC.
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Dates
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Enumeration Date | 11/02/2011
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Last Update Date | 11/02/2011
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Provider Practice Location Address
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Address Line | 2222 LAFAYETTE AVE
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City | TERRE HAUTE
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State | IN
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Zip | 47805-2916
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Country | US
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Telephone | 812-466-2400
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Fax | 812-466-5200
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Provider Business Mailing Address
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Address Line | 2222 LAFAYETTE AVE
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City | TERRE HAUTE
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State | IN
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Zip | 47805-2916
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Country | US
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Telephone | 812-466-2400
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Fax | 812-466-5200
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Authorized Official
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Title or Position | CEO
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Name | MS. JAMI L MARTIN
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Credential | MS
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Telephone | 812-466-2400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State | IN
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