Provider Demographics
NPI:1659071520
Name:CONNECTIONSWA, LLC
Entity Type:Organization
Organization Name:CONNECTIONSWA, LLC
Other - Org Name:OUTPATIENT SERVICES (CLINIC)
Other - Org Type:Other Name
Authorized Official - Title/Position:PROVIDER NETWORK MANAGEMENT ASSOC
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:TALAS DENNY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-273-6154
Mailing Address - Street 1:2390 E CAMELBACK RD STE 400
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-3479
Mailing Address - Country:US
Mailing Address - Phone:602-416-7647
Mailing Address - Fax:
Practice Address - Street 1:11410 NE 122ND WAY BLDG A1
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-6945
Practice Address - Country:US
Practice Address - Phone:602-416-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-08
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)