MEDICARE: INTERCONNECTED FAMILY AND CHILDREN SERVICES LLC

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	251B00000X	Case Management Agency	CSW004040	GA

General Provider Information

NPI Number	:	1609210582
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERCONNECTED FAMILY AND CHILDREN SERVICES LLC

Provider Business Mailing Address
First Line	:	1257 COMMERCIAL DR SW # SR
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30094-5991
Country	:	US
Telephone Number	:	678-365-2375
Fax Number	:	678-298-5098

Provider Business Practice Location Address
First Line	:	1257 COMMERCIAL DR SW # SR
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30094-5991
Country	:	US
Telephone Number	:	678-365-2375
Fax Number	:	678-298-5098

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	CHRIS YOUNG
Credential	:
Telephone Number	:	678-365-2375

Provider Enumeration Date	:	04/23/2013
Last Update Date	:	04/23/2013

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