Provider Demographics
NPI:1255079638
Name:COMMUNITY CONNECTIONS
Entity type:Organization
Organization Name:COMMUNITY CONNECTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QUALITY ASSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-220-6117
Mailing Address - Street 1:721 STEDMAN ST
Mailing Address - Street 2:
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-6632
Mailing Address - Country:US
Mailing Address - Phone:907-220-6117
Mailing Address - Fax:
Practice Address - Street 1:721 STEDMAN ST
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-6632
Practice Address - Country:US
Practice Address - Phone:907-220-6117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty