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General NPI Number Information
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NPI Number | 1639082159
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Entity Type | Organization
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Legal Business Name | COMMUNITY CONNECT RI LLC
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Dates
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Enumeration Date | 09/25/2026
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Last Update Date | 09/25/2026
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Provider Practice Location Address
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Address Line | 560 MINERAL SPRING AVE
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City | PAWTUCKET
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State | RI
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Zip | 02860-3363
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Country | US
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Telephone | 401-696-7090
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Fax |
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Provider Business Mailing Address
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Address Line | 560 MINERAL SPRING AVE
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City | PAWTUCKET
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State | RI
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Zip | 02860-3363
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Country | US
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Telephone | 401-696-7090
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Fax |
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Authorized Official
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Title or Position | OWNER / AUTHORIZED OFFICIAL
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Name | ZDAHMOND DALE
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Credential | CPRS
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Telephone | 401-696-7090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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