Provider Demographics
NPI:1619325255
Name:COMMUNITY CONNECT CARE LLC
Entity Type:Organization
Organization Name:COMMUNITY CONNECT CARE LLC
Other - Org Name:SHERRI CAMPBELL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:34007156A
Authorized Official - Phone:317-529-9155
Mailing Address - Street 1:6801 LAKE PLAZA DR STE A111
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-4069
Mailing Address - Country:US
Mailing Address - Phone:317-529-9155
Mailing Address - Fax:
Practice Address - Street 1:6801 LAKE PLAZA DR STE A111
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-4069
Practice Address - Country:US
Practice Address - Phone:317-529-9155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-24
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34007156A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health