Provider Demographics
NPI:1255088209
Name:CONNECTICUT COMMUNITY FOCUS LLC
Entity type:Organization
Organization Name:CONNECTICUT COMMUNITY FOCUS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTOINETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOOMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-558-4189
Mailing Address - Street 1:262 BELLA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-1362
Mailing Address - Country:US
Mailing Address - Phone:203-558-4189
Mailing Address - Fax:203-262-0046
Practice Address - Street 1:262 BELLA VISTA DR
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:CT
Practice Address - Zip Code:06795-1362
Practice Address - Country:US
Practice Address - Phone:203-558-4189
Practice Address - Fax:203-262-0046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTHCA.0001940OtherDCP REGISTRATION #