MEDICARE: TIMMY COMMUNITY CONNECTIONS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	251K00000X	Public Health or Welfare Agency
3	251V00000X	Voluntary or Charitable Agency
4	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1689261083
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIMMY COMMUNITY CONNECTIONS

Provider Business Mailing Address
First Line	:	11001 S MICHIGAN AVE STE 103
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60628-4308
Country	:	US
Telephone Number	:	773-313-9040
Fax Number	:

Provider Business Practice Location Address
First Line	:	11001 S MICHIGAN AVE STE 103
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60628-4308
Country	:	US
Telephone Number	:	773-313-9040
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ALESIA CARLOCK
Credential	:
Telephone Number	:	224-229-2029

Provider Enumeration Date	:	12/31/2020
Last Update Date	:	03/07/2022

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Directions to “TIMMY COMMUNITY CONNECTIONS ” Practice Location

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