MEDICARE: CARE CONNECT, INC.

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1215417100
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARE CONNECT, INC.

Provider Business Mailing Address
First Line	:	PO BOX 341414
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53234-1414
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4319 N 76TH ST STE 10
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53222-2056
Country	:	US
Telephone Number	:	414-488-9396
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ROOSEVELT RICHARDSON
Credential	:
Telephone Number	:	414-801-0778

Provider Enumeration Date	:	08/20/2018
Last Update Date	:	06/11/2019

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