Provider Demographics
NPI:1962889055
Name:COMMUNITY CONNECTIONS SOUTH CENTRAL
Entity type:Organization
Organization Name:COMMUNITY CONNECTIONS SOUTH CENTRAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANI
Authorized Official - Middle Name:
Authorized Official - Last Name:SNELLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-377-9814
Mailing Address - Street 1:1675 S MAPLE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-2531
Mailing Address - Country:US
Mailing Address - Phone:208-377-9814
Mailing Address - Fax:208-375-5803
Practice Address - Street 1:212 2ND AVE W
Practice Address - Street 2:#102 & 104
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-6016
Practice Address - Country:US
Practice Address - Phone:208-733-0655
Practice Address - Fax:208-733-1389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-28
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services