COMMUNITY RESOURCE CENTER INC. NPI 1184850349

NPI Information

NPI: 1184850349
Provider Name: COMMUNITY RESOURCE CENTER INC.
Classification: Clinic/Center - 261QR0405X
Entity Type: Organization

Specialization: Rehabilitation, Substance Use Disorder

CLIA Number: 14D2090499

Address:
421 W MAIN ST
VANDALIA, IL
ZIP 62471
Phone: (618) 283-4229
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COMMUNITY RESOURCE CENTER INC. is a rehabilitation and substance use disorder clinic center in Vandalia, IL. COMMUNITY RESOURCE CENTER INC. NPI is 1184850349. The provider is registered as an organization entity type.

The provider's business location address is:

421 W MAIN ST
VANDALIA, IL
ZIP 62471-214
Phone: (618) 283-4229
Fax: (618) 283-9203

The provider's authorized official is Georgianne Broughton .
The authorized official title is Executive Director and has the following contact phone number (618) 533-1391.

The CLIA number assigned to this NPI record is 14D2090499 - other - otpt substance abuse ctr with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/2/2009 and was last updated on 12/17/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	671700	OTHER	ILLINOIS	MEDICARE
2	04035	MEDICAID	ILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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