Provider Demographics
NPI:1053470260
Name:CONNECTIONS CSP, INC.
Entity Type:Organization
Organization Name:CONNECTIONS CSP, INC.
Other - Org Name:BLACKBIRD LANDING GROUP HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEVON
Authorized Official - Middle Name:Z
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-377-2358
Mailing Address - Street 1:3821 LANCASTER PIKE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-1512
Mailing Address - Country:US
Mailing Address - Phone:302-442-6622
Mailing Address - Fax:302-984-3385
Practice Address - Street 1:994 BLACKBIRD LANDING RD
Practice Address - Street 2:
Practice Address - City:TOWNSEND
Practice Address - State:DE
Practice Address - Zip Code:19734-9141
Practice Address - Country:US
Practice Address - Phone:302-659-0512
Practice Address - Fax:302-659-3949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1518261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001185561Medicaid