Provider Demographics
NPI:1255004057
Name:COMMUNITY BASED CONNECTIONS, INC.
Entity Type:Organization
Organization Name:COMMUNITY BASED CONNECTIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MIKELANGE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLBEL
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:954-908-5249
Mailing Address - Street 1:1021 NW 6TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33311-8055
Mailing Address - Country:US
Mailing Address - Phone:954-908-5249
Mailing Address - Fax:954-524-2119
Practice Address - Street 1:1021 NW 6TH ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33311-8055
Practice Address - Country:US
Practice Address - Phone:954-908-5249
Practice Address - Fax:954-524-2119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health