Provider Demographics
NPI:1811713472
Name:SUPPORTING COMPASSIONATE CONNECTIONS
Entity type:Organization
Organization Name:SUPPORTING COMPASSIONATE CONNECTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JENIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:STAPLETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-350-3846
Mailing Address - Street 1:217 OAK LN
Mailing Address - Street 2:
Mailing Address - City:CRESCO
Mailing Address - State:PA
Mailing Address - Zip Code:18326-7880
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:217 OAK LN
Practice Address - Street 2:
Practice Address - City:CRESCO
Practice Address - State:PA
Practice Address - Zip Code:18326-7880
Practice Address - Country:US
Practice Address - Phone:570-350-3846
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-28
Last Update Date:2024-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management