Provider Demographics
NPI:1205000817
Name:COMMUNITY CONNECTION PROGRAMS INC
Entity Type:Organization
Organization Name:COMMUNITY CONNECTION PROGRAMS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANDA
Authorized Official - Middle Name:CHAVIS
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-361-7871
Mailing Address - Street 1:1799 STUMPF BLVD BLDG 5
Mailing Address - Street 2:STE 6
Mailing Address - City:TERRYTOWN
Mailing Address - State:LA
Mailing Address - Zip Code:70056
Mailing Address - Country:US
Mailing Address - Phone:504-361-7871
Mailing Address - Fax:504-361-7971
Practice Address - Street 1:1799 STUMPF BLVD BLDG 5
Practice Address - Street 2:
Practice Address - City:TERRYTOWN
Practice Address - State:LA
Practice Address - Zip Code:70056-3950
Practice Address - Country:US
Practice Address - Phone:504-361-7871
Practice Address - Fax:504-361-7971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11117083747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1111708Medicaid