Provider Demographics
NPI:1669087284
Name:CONNECTIVE CARE LLC
Entity type:Organization
Organization Name:CONNECTIVE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:RACHIEL
Authorized Official - Middle Name:LEANN
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:662-446-6900
Mailing Address - Street 1:398 E MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-4037
Mailing Address - Country:US
Mailing Address - Phone:662-446-6900
Mailing Address - Fax:
Practice Address - Street 1:398 E MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-4037
Practice Address - Country:US
Practice Address - Phone:662-446-6900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-10
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty