Community Connection Support Services, LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

2754-08-011 Issued in VA

Legal business name

COMMUNITY CONNECTION SUPPORT SERVICES, LLC

Practice address

2460 Hebron Rd
Galax, VA 24333-5280

Phone

(276) 233-2817

Fax

(800) 866-3885

NPI assigned

Oct 26, 2016

Last updated

Oct 26, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Cheryl Grimm

Title

Director

Phone

(276) 233-2817

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1477440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477440000000",
    "number": "1770035750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2460 HEBRON RD",
            "city": "GALAX",
            "state": "VA",
            "postal_code": "243335280",
            "telephone_number": "276-233-2817",
            "fax_number": "800-866-3885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2460 HEBRON RD",
            "city": "GALAX",
            "state": "VA",
            "postal_code": "243335280",
            "telephone_number": "276-233-2817",
            "fax_number": "800-866-3885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY CONNECTION SUPPORT SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-26",
        "last_updated": "2016-10-26",
        "status": "A",
        "authorized_official_last_name": "GRIMM",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "276-233-2817",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "VA",
            "license": "2754-08-011",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dale Clymer, LCSW
• Mary Kay Cole-Mitchell, LCSW
• Charles Collins
• Jill Marie Combs
• Commonwealth of Virginia State Board of Health (Galax City Health Dept)
• Larry Cook, PT, DPT
• Benjamin Coulthard, DPT
• Myra Joy Cox
• Rose Renae Cox, LPC
• Samuel Cleveland Cox, RPH

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Galax, VA
• Providers in Galax, VA by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.