MEDICARE: THE CONNECTION CHURCH CORPORATION

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1235782608
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE CONNECTION CHURCH CORPORATION

Provider Business Mailing Address
First Line	:	700 GENERATION PT
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34744-5957
Country	:	US
Telephone Number	:	407-744-7007
Fax Number	:

Provider Business Practice Location Address
First Line	:	4117 NEPTUNE RD
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34769-6741
Country	:	US
Telephone Number	:	407-729-5847
Fax Number	:

Authorized Official
Title or Position	:	ASSOCIATE PASTOR
Name	:	MR. THOMAS N TODD JR.
Credential	:	MDIV MA
Telephone Number	:	407-729-5847

Provider Enumeration Date	:	07/24/2019
Last Update Date	:	07/24/2019

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Directions to “THE CONNECTION CHURCH CORPORATION ” Practice Location

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