Healthcare Provider Details

I. General information

NPI: 1821614702
Provider Name (Legal Business Name): COMMUNITY CARE RESOURCES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2020
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 BOSTON AVE STE 204
ALTAMONTE SPRINGS FL
32701-4712
US

IV. Provider business mailing address

15800 PINES BLVD STE 330
PEMBROKE PINES FL
33027-1212
US

V. Phone/Fax

Practice location:
  • Phone: 407-401-7457
  • Fax: 754-210-2734
Mailing address:
  • Phone: 954-362-5432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA BARNHART
Title or Position: DIRECTOR
Credential:
Phone: 877-287-2520