NPIMap

Organization Active NPI

Community Connections Family Life Center LLC

  • Public Health & General Preventive Medicine Physician
  • High Point, NC
National Provider Identifier
1992005805
Registry record updated Mar 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health & General Preventive Medicine PhysicianTaxonomy code 2083P0901X
Legal business name
COMMUNITY CONNECTIONS FAMILY LIFE CENTER LLC
Practice address
622 N Hamilton St
Suite 104
High Point, NC 27262-4076
Phone
(336) 253-1268
NPI assigned
Oct 26, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2011

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

Authorized official

Name
Letonya Shaw
Title
Director
Phone
(336) 253-1268

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Nutrition Education NutritionistGroup: 193200000X MULTI-SPECIALTY GROUP 133NN1002X NC
Registered DietitianGroup: 193200000X MULTI-SPECIALTY GROUP 133V00000X NC
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Public Health & General Preventive Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2083P0901X Primary
Community/Behavioral Health Agency 251S00000X
Early Intervention Provider Agency 252Y00000X

Addresses

Primary practice location

622 N Hamilton St
Suite 104
High Point, NC 27262-4076

Mailing address

PO Box 47
High Point, NC 27261-0047
Phone (336) 884-7179

National Provider Directory

National Provider Directory
Tax ID family
Community Connections Family Life Center LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1288051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299196800000",
    "number": "1992005805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 47",
            "city": "HIGH POINT",
            "state": "NC",
            "postal_code": "272610047",
            "telephone_number": "336-884-7179",
            "fax_number": "336-884-7189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "622 N HAMILTON ST",
            "address_2": "SUITE 104",
            "city": "HIGH POINT",
            "state": "NC",
            "postal_code": "272624076",
            "telephone_number": "336-253-1268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY CONNECTIONS FAMILY LIFE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-26",
        "last_updated": "2011-03-04",
        "status": "A",
        "authorized_official_last_name": "SHAW",
        "authorized_official_first_name": "LETONYA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "336-253-1268"
    },
    "taxonomies": [
        {
            "code": "133NN1002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nutritionist, Nutrition, Education",
            "state": "NC",
            "license": null,
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": "NC",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2083P0901X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in High Point, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2011; 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.