MEDICARE: COMMUNITY CONNECTIONS NORTHEAST OHIO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1194320739
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY CONNECTIONS NORTHEAST OHIO

Provider Business Mailing Address
First Line	:	1647 BRITTAIN RD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44310-2701
Country	:	US
Telephone Number	:	234-251-2626
Fax Number	:

Provider Business Practice Location Address
First Line	:	1647 BRITTAIN RD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44310-2701
Country	:	US
Telephone Number	:	234-251-2626
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	ROBIN R BACOLA
Credential	:	MS. ED
Telephone Number	:	234-251-2626

Provider Enumeration Date	:	12/02/2020
Last Update Date	:	12/15/2020

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