Healthcare Provider Details

I. General information

NPI: 1225434855
Provider Name (Legal Business Name): COMMUNITY RESOURCE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2014
Last Update Date: 12/30/2019
Certification Date: 12/30/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 2ND STREET
ENCINITAS CA
92024
US

IV. Provider business mailing address

650 2ND STREET
ENCINITAS CA
92024
US

V. Phone/Fax

Practice location:
  • Phone: 760-753-8300
  • Fax: 760-753-0252
Mailing address:
  • Phone: 760-753-1156
  • Fax: 760-753-0252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: JOHN VANCLEEF
Title or Position: CEO
Credential:
Phone: 760-260-6309