Healthcare Provider Details

I. General information

NPI: 1396684130
Provider Name (Legal Business Name): COMMUNITY RESOURCE NETWORK OF FLORIDA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 FENTRESS BLVD UNIT C
DAYTONA BEACH FL
32114-1287
US

IV. Provider business mailing address

700 FENTRESS BLVD UNIT C
DAYTONA BEACH FL
32114-1287
US

V. Phone/Fax

Practice location:
  • Phone: 239-415-7400
  • Fax:
Mailing address:
  • Phone: 239-415-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: LISA JEROME
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 239-247-2041