Provider Demographics
NPI:1407075658
Name:COMMUNITY CONNECTION
Entity Type:Organization
Organization Name:COMMUNITY CONNECTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM COORIDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BOSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-425-8132
Mailing Address - Street 1:300 HARVEY WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-2103
Mailing Address - Country:US
Mailing Address - Phone:831-425-8132
Mailing Address - Fax:831-425-4581
Practice Address - Street 1:300 HARVEY WEST BLVD
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-2103
Practice Address - Country:US
Practice Address - Phone:831-425-8132
Practice Address - Fax:831-425-4581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)