Provider Demographics
NPI:1770035750
Name:COMMUNITY CONNECTION SUPPORT SERVICES, LLC
Entity Type:Organization
Organization Name:COMMUNITY CONNECTION SUPPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-233-2817
Mailing Address - Street 1:2460 HEBRON RD
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-5280
Mailing Address - Country:US
Mailing Address - Phone:276-233-2817
Mailing Address - Fax:800-866-3885
Practice Address - Street 1:2460 HEBRON RD
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-5280
Practice Address - Country:US
Practice Address - Phone:276-233-2817
Practice Address - Fax:800-866-3885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2754-08-011320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities