Provider Demographics
NPI:1720821358
Name:COMMUNITY CONNECTIONS & NETWORKS LLC
Entity type:Organization
Organization Name:COMMUNITY CONNECTIONS & NETWORKS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KISHA
Authorized Official - Middle Name:S
Authorized Official - Last Name:CAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:601-695-4399
Mailing Address - Street 1:1041 EASTER ST
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39059-3021
Mailing Address - Country:US
Mailing Address - Phone:601-695-4399
Mailing Address - Fax:
Practice Address - Street 1:1041 EASTER ST
Practice Address - Street 2:
Practice Address - City:CRYSTAL SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39059-3021
Practice Address - Country:US
Practice Address - Phone:601-695-4399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251G00000XAgenciesHospice Care, Community Based
No251S00000XAgenciesCommunity/Behavioral Health
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances