Provider Demographics
NPI:1043845399
Name:COMPANION CONNECTIONS
Entity Type:Organization
Organization Name:COMPANION CONNECTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KARANJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:774-530-1938
Mailing Address - Street 1:25 BJORKLUND AVE
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-1065
Mailing Address - Country:US
Mailing Address - Phone:774-530-1938
Mailing Address - Fax:
Practice Address - Street 1:25 BJORKLUND AVE
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-1065
Practice Address - Country:US
Practice Address - Phone:774-530-1938
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health