1336201938 NPI number — CONNECTIONS COMMUNITY SUPPORT PROGRAMS INC.

Table of content: (NPI 1336201938)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336201938 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:
CHRIS STURMFELS GROUP HOME
Provider Other Organization Name Type Code:
3
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:
1336201938
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2019
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:
800 BELLEVUE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19809-2208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-764-6710
Provider Business Practice Location Address Fax Number:
302-764-6730
Provider Enumeration Date:
12/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DEVANEY MCKAY
Authorized Official First Name:
CATHERINE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
302-230-9103

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  1808 , 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)

  • Identifier: 0000520261 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".




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