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General NPI Number Information
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NPI Number | 1811381577
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Entity Type | Organization
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Legal Business Name | CLINICAL CONNECTIONS TARGETED CASE MANAGEMENT
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Dates
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Enumeration Date | 03/20/2015
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 250 WILSHIRE BLVD SUITE 136
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City | CASSELBERRY
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State | FL
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Zip | 32707-5377
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Country | US
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Telephone | 407-739-8462
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Fax |
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Provider Business Mailing Address
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Address Line | 250 WILSHIRE BLVD SUITE 136
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City | CASSELBERRY
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State | FL
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Zip | 32707-5377
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | TARGETED CASE MANAGER
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Name | LESLIE BLOUNT
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Credential |
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Telephone | 407-739-8462
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State | FL
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