MEDICARE: COMMONWEALTH CARING CONNECTIONS

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1902652761
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMONWEALTH CARING CONNECTIONS

Provider Business Mailing Address
First Line	:	11801 BIRDIE LN
Second Line	:
City	:	CHESTER
State	:	VA
Zip	:	23831-1600
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	605 N COURTHOUSE RD STE 201B
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23236-4068
Country	:	US
Telephone Number	:	804-946-0060
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	DANIELLE ALSTON
Credential	:
Telephone Number	:	804-519-3482

Provider Enumeration Date	:	04/24/2024
Last Update Date	:	04/24/2024

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