Provider Demographics
NPI:1063422038
Name:CARECONNECT HEALTH, INC.
Entity type:Organization
Organization Name:CARECONNECT HEALTH, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-273-8881
Mailing Address - Street 1:PO BOX 357
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31825-0357
Mailing Address - Country:US
Mailing Address - Phone:229-887-3324
Mailing Address - Fax:229-887-2559
Practice Address - Street 1:510 ALSTON ST STE A
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:GA
Practice Address - Zip Code:31825-6012
Practice Address - Country:US
Practice Address - Phone:229-887-3324
Practice Address - Fax:229-887-2559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000219678AMedicaid
GA000219678AMedicaid