Provider Demographics
NPI:1528556990
Name:CARECONNECT HEALTH, INC.
Entity Type:Organization
Organization Name:CARECONNECT HEALTH, INC.
Other - Org Name:PEDIATRIC CONVENIENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-273-8881
Mailing Address - Street 1:P.O. BOX 5610
Mailing Address - Street 2:
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31010
Mailing Address - Country:US
Mailing Address - Phone:229-273-8881
Mailing Address - Fax:229-273-8985
Practice Address - Street 1:1909 HWY. 82 WEST
Practice Address - Street 2:SUITES 3 & 4
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31793
Practice Address - Country:US
Practice Address - Phone:229-445-3509
Practice Address - Fax:229-445-3513
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARECONNECT HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-01
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)