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General NPI Number Information
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NPI Number | 1871935064
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Entity Type | Organization
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Legal Business Name | COMMUNITY CONNECTIONS NORTH, INC.
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Dates
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Enumeration Date | 07/29/2013
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Last Update Date | 07/29/2013
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Provider Practice Location Address
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Address Line | 1230 N NORTHWOOD CENTER CT SUITE A
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City | COEUR D ALENE
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State | ID
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Zip | 83814-4941
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Country | US
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Telephone | 208-664-1065
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Fax | 208-765-2258
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Provider Business Mailing Address
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Address Line | 1675 S MAPLE GROVE RD
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City | BOISE
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State | ID
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Zip | 83709-2531
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Country | US
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Telephone | 208-377-9814
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. BRENDA NEIGHBORS
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Credential |
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Telephone | 208-377-9814
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | DDA-3922
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | RHA-3904
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License Number State | ID
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