Provider Demographics
NPI:1598328577
Name:THE CONNECTION FL, LLC
Entity Type:Organization
Organization Name:THE CONNECTION FL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:KORCOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-288-2555
Mailing Address - Street 1:2151 E COMMERCIAL BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-3807
Mailing Address - Country:US
Mailing Address - Phone:954-288-2555
Mailing Address - Fax:
Practice Address - Street 1:2151 E COMMERCIAL BLVD STE 301
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-3807
Practice Address - Country:US
Practice Address - Phone:954-288-2555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1134527435OtherSELF PAY AND COMMERCIAL INS