Provider Demographics
NPI:1689261083
Name:TIMMY COMMUNITY CONNECTIONS
Entity type:Organization
Organization Name:TIMMY COMMUNITY CONNECTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALESIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-229-2029
Mailing Address - Street 1:11001 S MICHIGAN AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-4308
Mailing Address - Country:US
Mailing Address - Phone:773-313-9040
Mailing Address - Fax:
Practice Address - Street 1:11001 S MICHIGAN AVE STE 103
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-4308
Practice Address - Country:US
Practice Address - Phone:773-313-9040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-31
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or Welfare
No251V00000XAgenciesVoluntary or Charitable