1013264415 NPI number — CONNECTIONS COMMUNITY SUPPORT PROGRAMS, INC.

Table of content: (NPI 1013264415)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013264415 NPI number — CONNECTIONS COMMUNITY SUPPORT PROGRAMS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONNECTIONS COMMUNITY SUPPORT PROGRAMS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013264415
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/04/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3821 LANCASTER PIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19805-1512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-442-6622
Provider Business Mailing Address Fax Number:
302-984-3385

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1423 CAPITOL TRAIL (BLDG. 1), SUITE 1210
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-894-7900
Provider Business Practice Location Address Fax Number:
302-737-1460
Provider Enumeration Date:
08/06/2012

Additional Information

Authorized Official

Authorized Official Last Name:
HICKS
Authorized Official First Name:
JEVON
Authorized Official Middle Name:
Z
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
302-377-2358

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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