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General NPI Number Information
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NPI Number | 1215603808
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Entity Type | Organization
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Legal Business Name | COMPLETE CARE CONNECTIONS LLC
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Dates
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Enumeration Date | 08/23/2021
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Last Update Date | 04/06/2022
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Provider Practice Location Address
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Address Line | 3504 DIAMOND SPRINGS DR
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City | RALEIGH
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State | NC
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Zip | 27610-2481
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Country | US
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Telephone | 336-624-2937
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Fax |
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Provider Business Mailing Address
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Address Line | 3504 DIAMOND SPRINGS DR
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City | RALEIGH
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State | NC
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Zip | 27610-2481
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Country | US
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Telephone | 336-624-2937
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JOLEEN ANTONIA ANDREWS
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Credential | OT/L
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Telephone | 336-624-2937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224ZE0001X
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Taxonomy Name | Environmental Modification Occupational Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225XE0001X
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Taxonomy Name | Environmental Modification Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225XG0600X
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Taxonomy Name | Gerontology Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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