Provider Demographics
NPI:1689791915
Name:D & D COMMUNITY CONNECTIONS
Entity Type:Organization
Organization Name:D & D COMMUNITY CONNECTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIANN
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKWITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-651-0201
Mailing Address - Street 1:1041 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-5548
Mailing Address - Country:US
Mailing Address - Phone:318-651-0201
Mailing Address - Fax:318-651-0221
Practice Address - Street 1:1041 N 9TH ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5548
Practice Address - Country:US
Practice Address - Phone:318-651-0201
Practice Address - Fax:318-651-0221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPCA 9098305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1537250Medicaid