Provider Demographics
NPI:1215110382
Name:COMMUNITY CONNECTIONS
Entity type:Organization
Organization Name:COMMUNITY CONNECTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BESS
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
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
Practice Address - Street 2:SUITE 241
Practice Address - City:CRAIG
Practice Address - State:AK
Practice Address - Zip Code:99921-0064
Practice Address - Country:US
Practice Address - Phone:907-826-3891
Practice Address - Fax:907-826-3892
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY CONNECTIONS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-12
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK292852251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1028252Medicaid