Provider Demographics
NPI:1417109026
Name:COMMUNITY CONNECTIONS PARTNERSHIP
Entity Type:Organization
Organization Name:COMMUNITY CONNECTIONS PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-646-2400
Mailing Address - Street 1:475 CLEVELAND AVE N
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-5031
Mailing Address - Country:US
Mailing Address - Phone:651-646-2400
Mailing Address - Fax:651-646-8024
Practice Address - Street 1:475 CLEVELAND AVE N
Practice Address - Street 2:SUITE 101
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-5031
Practice Address - Country:US
Practice Address - Phone:651-646-2400
Practice Address - Fax:651-646-8024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNM348060700Medicaid
MNA002525900Medicaid
MNA318013100Medicaid