Provider Demographics
NPI:1760925556
Name:CONNECT CARE NETWORK INC.
Entity Type:Organization
Organization Name:CONNECT CARE NETWORK INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED NURSE TECHNICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CHANTE
Authorized Official - Middle Name:
Authorized Official - Last Name:RESPRESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-372-7126
Mailing Address - Street 1:19761 ANNOTT ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48205-1603
Mailing Address - Country:US
Mailing Address - Phone:313-372-7126
Mailing Address - Fax:313-372-7126
Practice Address - Street 1:19761 ANNOTT ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48205-1603
Practice Address - Country:US
Practice Address - Phone:313-372-7126
Practice Address - Fax:313-372-7126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI225XP0019X, 320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical RehabilitationGroup - Single Specialty
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical DisabilitiesGroup - Single Specialty