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General NPI Number Information
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NPI Number | 1518112549
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Entity Type | Organization
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Legal Business Name | COMMUNITY CONNECTIONS, LLC
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Dates
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Enumeration Date | 11/18/2008
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Last Update Date | 11/18/2008
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Provider Practice Location Address
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Address Line | 5907 ELLIS WOODS WAY
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City | RICHMOND
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State | VA
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Zip | 23225-7363
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Country | US
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Telephone | 804-358-7400
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Fax | 804-358-7442
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Provider Business Mailing Address
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Address Line | 5907 ELLIS WOODS WAY
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City | RICHMOND
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State | VA
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Zip | 23225-7363
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Country | US
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Telephone | 804-358-7400
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Fax | 804-358-7442
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Authorized Official
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Title or Position | CHIEF ADMINISTRATIVE OFFICER
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Name | KAREN YOUNG
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Credential |
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Telephone | 804-358-7400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 752-05-001
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License Number State | VA
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