Provider Demographics
NPI: | 1033718606 |
---|---|
Name: | COMMUNITY CONNECTIONS, INC. |
Entity type: | Organization |
Organization Name: | COMMUNITY CONNECTIONS, INC. |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | EXECUTIVE DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | TANDRA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | THOMPSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 907-225-7825 |
Mailing Address - Street 1: | 721 STEDMAN ST |
Mailing Address - Street 2: | |
Mailing Address - City: | KETCHIKAN |
Mailing Address - State: | AK |
Mailing Address - Zip Code: | 99901-6632 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 907-225-7825 |
Mailing Address - Fax: | 907-225-1541 |
Practice Address - Street 1: | 1800 CRAIG KLAWOCK HWY STE 241 |
Practice Address - Street 2: | |
Practice Address - City: | CRAIG |
Practice Address - State: | AK |
Practice Address - Zip Code: | 99921-0678 |
Practice Address - Country: | US |
Practice Address - Phone: | 907-826-3891 |
Practice Address - Fax: | 907-826-3892 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2020-10-23 |
Last Update Date: | 2025-07-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
AK | 1712659 | Medicaid |