Healthcare Provider Details

I. General information

NPI: 1740184647
Provider Name (Legal Business Name): COMMUNITY RESOURCE CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 E. MARTIN LUTHER KING DRIVE
CENTRALIA IL
62801-3058
US

IV. Provider business mailing address

904 E. MARTIN LUTHER KING DRIVE
CENTRALIA IL
62801-3058
US

V. Phone/Fax

Practice location:
  • Phone: 618-533-1391
  • Fax: 618-533-0012
Mailing address:
  • Phone: 618-533-1391
  • Fax: 618-533-0012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: LINDSAY M SMITH
Title or Position: ADMINISTRATIVE SERVICES COORDINATOR
Credential:
Phone: 618-533-1391