Provider Demographics
NPI:1649812199
Name:COMMUNITY CONNECTIONS FAMILY RESOURCE CENTER,LLC
Entity type:Organization
Organization Name:COMMUNITY CONNECTIONS FAMILY RESOURCE CENTER,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SARAI
Authorized Official - Middle Name:
Authorized Official - Last Name:NANCE
Authorized Official - Suffix:
Authorized Official - Credentials:BA IN THEOLOGY
Authorized Official - Phone:414-739-7039
Mailing Address - Street 1:9330 W LINCOLN AVE # A22
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2300
Mailing Address - Country:US
Mailing Address - Phone:414-484-6247
Mailing Address - Fax:414-494-6247
Practice Address - Street 1:9330 W LINCOLN AVE STE A22
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53227-2300
Practice Address - Country:US
Practice Address - Phone:414-484-6247
Practice Address - Fax:414-484-6247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care