Provider Demographics
NPI:1689441586
Name:CONNECTED TO RECOVER
Entity Type:Organization
Organization Name:CONNECTED TO RECOVER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DENESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGRAFFENREID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-850-9087
Mailing Address - Street 1:6047 TYVOLA GLEN CIR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-6431
Mailing Address - Country:US
Mailing Address - Phone:803-804-3222
Mailing Address - Fax:
Practice Address - Street 1:6047 TYVOLA GLEN CIR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-6431
Practice Address - Country:US
Practice Address - Phone:980-850-9087
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health