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General NPI Number Information
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NPI Number | 1972829034
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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 | 04/14/2010
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Last Update Date | 05/12/2014
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Provider Practice Location Address
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Address Line | 18215 N 11TH DR
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City | PHOENIX
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State | AZ
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Zip | 85023-1464
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Country | US
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Telephone | 602-283-5267
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Fax |
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Provider Business Mailing Address
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Address Line | 18215 N 11TH DR
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City | PHOENIX
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State | AZ
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Zip | 85023-1464
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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 | CEO
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Name | JOEL TEMPLE
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Credential |
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Telephone | 602-509-5248
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number | BH-3555
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License Number State | AZ
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