Organization
COMMUNITY CONNECTION, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARCELYN ROE (OWNER/DIRECTOR)
(913) 851-2617
Entity
Organization
Contact information
Practice address
11300 W 175TH ST, OLATHE, KS 66062-9468
(913) 851-2617
(913) 851-2617
Mailing address
11300 W 175TH ST, OLATHE, KS 66062-9468
(913) 851-2617
(913) 851-2617
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200375770B
—
KS
Enumeration date
10/03/2013
Last updated
10/03/2013
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