Provider Demographics
NPI: | 1851880157 |
---|---|
Name: | HEALTH CONNECTIONS INCORPORATED |
Entity Type: | Organization |
Organization Name: | HEALTH CONNECTIONS INCORPORATED |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | EXECUTIVE DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ERICKA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SINCLAIR |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MS, MPH |
Authorized Official - Phone: | 404-218-3686 |
Mailing Address - Street 1: | PO BOX 170635 |
Mailing Address - Street 2: | |
Mailing Address - City: | MILWAUKEE |
Mailing Address - State: | WI |
Mailing Address - Zip Code: | 53217-8051 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 404-218-3686 |
Mailing Address - Fax: | 414-269-8280 |
Practice Address - Street 1: | 4655 N PORT WASHINGTON RD STE 325 |
Practice Address - Street 2: | |
Practice Address - City: | GLENDALE |
Practice Address - State: | WI |
Practice Address - Zip Code: | 53212-1000 |
Practice Address - Country: | US |
Practice Address - Phone: | 404-218-3686 |
Practice Address - Fax: | 414-269-8280 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2018-05-02 |
Last Update Date: | 2020-09-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
101Y00000X, 101YP2500X, 104100000X, 207Q00000X, 2084P0800X, 208D00000X, 251B00000X, 251K00000X, 261Q00000X, 261QM1300X, 261QP2300X, 261QR0400X, 363LP0808X | ||
WI | 291U00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center | Group - Multi-Specialty | |
No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty | |
No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 208D00000X | Allopathic & Osteopathic Physicians | General Practice | Group - Multi-Specialty | |
No | 251B00000X | Agencies | Case Management | Group - Multi-Specialty | |
No | 251K00000X | Agencies | Public Health or Welfare | Group - Multi-Specialty | |
No | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | Group - Multi-Specialty |
No | 261QP2300X | Ambulatory Health Care Facilities | Clinic/Center | Primary Care | |
No | 261QR0400X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation | Group - Multi-Specialty |
No | 291U00000X | Laboratories | Clinical Medical Laboratory | Group - Multi-Specialty | |
No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
WI | 100082930 | Medicaid |