Provider Demographics
NPI:1316744196
Name:COMMUNITY-CONNECT HOME CARE LLC
Entity type:Organization
Organization Name:COMMUNITY-CONNECT HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NEVIL
Authorized Official - Middle Name:
Authorized Official - Last Name:GENJANG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:240-486-4147
Mailing Address - Street 1:17891 ELDER AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-4984
Mailing Address - Country:US
Mailing Address - Phone:240-486-4147
Mailing Address - Fax:
Practice Address - Street 1:17891 ELDER AVE
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-4984
Practice Address - Country:US
Practice Address - Phone:240-486-4147
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health