Provider Demographics
NPI:1255926564
Name:COMMUNITY SUPPORT CONNECTIONS
Entity type:Organization
Organization Name:COMMUNITY SUPPORT CONNECTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OLUWAFEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHODIPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-348-3981
Mailing Address - Street 1:3100 LORD BALTIMORE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-5804
Mailing Address - Country:US
Mailing Address - Phone:443-348-3981
Mailing Address - Fax:
Practice Address - Street 1:3100 LORD BALTIMORE DR STE 101
Practice Address - Street 2:
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244-5804
Practice Address - Country:US
Practice Address - Phone:443-348-3981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No251B00000XAgenciesCase Management
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity HealthGroup - Single Specialty