Provider Demographics
NPI:1275955577
Name:COMMUNITY CONNECTIONS FOR LIFE, INC
Entity Type:Organization
Organization Name:COMMUNITY CONNECTIONS FOR LIFE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:786-657-3276
Mailing Address - Street 1:18441 NW 2ND AVE STE 505
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-4562
Mailing Address - Country:US
Mailing Address - Phone:786-657-3276
Mailing Address - Fax:786-565-9193
Practice Address - Street 1:18441 NE 2 AVE SUITE 505
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169
Practice Address - Country:US
Practice Address - Phone:786-657-3276
Practice Address - Fax:786-565-9193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016455000Medicaid
FL010882700Medicaid