Provider Demographics
NPI:1710288428
Name:CARECONNECT HEALTH, INC.
Entity Type:Organization
Organization Name:CARECONNECT HEALTH, INC.
Other - Org Name:CARECONNECT FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-273-8881
Mailing Address - Street 1:P.O. BOX 5610
Mailing Address - Street 2:
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31010-1514
Mailing Address - Country:US
Mailing Address - Phone:229-273-8881
Mailing Address - Fax:229-273-8985
Practice Address - Street 1:101 MAYO STREET
Practice Address - Street 2:SUITE A
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3696
Practice Address - Country:US
Practice Address - Phone:229-924-4647
Practice Address - Fax:229-924-4597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-11
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003106464AMedicaid
GA111942Medicare Oscar/Certification