Provider Demographics
NPI:1629709704
Name:COMMONWEALTH CONNECTIONS
Entity Type:Organization
Organization Name:COMMONWEALTH CONNECTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-314-7667
Mailing Address - Street 1:3015 AUTUMN LAKE CV
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-4464
Mailing Address - Country:US
Mailing Address - Phone:270-314-7667
Mailing Address - Fax:
Practice Address - Street 1:3015 AUTUMN LAKE CV
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-4464
Practice Address - Country:US
Practice Address - Phone:270-314-7667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
No373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Multi-Specialty