Provider Demographics
NPI:1972783751
Name:A CARING CONNECTION
Entity type:Organization
Organization Name:A CARING CONNECTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER SOLE PROPRIETOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:FAY
Authorized Official - Last Name:VISNACK
Authorized Official - Suffix:
Authorized Official - Credentials:MA LPC
Authorized Official - Phone:719-276-0801
Mailing Address - Street 1:1335 PHAY AVE
Mailing Address - Street 2:STE E
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212
Mailing Address - Country:US
Mailing Address - Phone:719-276-0801
Mailing Address - Fax:
Practice Address - Street 1:1335 PHAY AVE
Practice Address - Street 2:STE E
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212
Practice Address - Country:US
Practice Address - Phone:719-276-0801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4116305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO475954Medicaid