Provider Demographics
NPI:1245398288
Name:CHRISTY HAFFORD
Entity Type:Organization
Organization Name:CHRISTY HAFFORD
Other - Org Name:COMMUNITY CONNECTION HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-262-4362
Mailing Address - Street 1:2321 S BELT LINE RD
Mailing Address - Street 2:STE 160
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-4181
Mailing Address - Country:US
Mailing Address - Phone:972-262-4362
Mailing Address - Fax:972-262-9853
Practice Address - Street 1:2321 S BELT LINE RD
Practice Address - Street 2:STE 160
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-4181
Practice Address - Country:US
Practice Address - Phone:972-262-4362
Practice Address - Fax:972-262-9853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007983251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001012443Medicaid
TX181065701Medicaid
TX001012444Medicaid
TX001015666Medicaid
TX001012443Medicaid