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General NPI Number Information
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NPI Number | 1679338974
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Entity Type | Organization
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Legal Business Name | CONNECT CORNER COMMUNITY CONNECTIONS LLC
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Dates
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Enumeration Date | 02/15/2024
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Last Update Date | 10/05/2024
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Provider Practice Location Address
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Address Line | 7700 S HARLEM AVE APT 1B
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City | BRIDGEVIEW
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State | IL
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Zip | 60455-1354
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Country | US
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Telephone | 708-553-3227
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Fax |
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Provider Business Mailing Address
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Address Line | 7700 S HARLEM AVE APT 1B
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City | BRIDGEVIEW
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State | IL
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Zip | 60455-1354
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Country | US
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Telephone | 708-553-3227
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Fax |
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Authorized Official
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Title or Position | CASE MANAGER/COORDINATOR
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Name | DAISY BYNUM
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Credential |
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Telephone | 708-553-3227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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