Healthcare Provider Details

I. General information

NPI: 1932377652
Provider Name (Legal Business Name): COMMUNITY RESOURCE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2008
Last Update Date: 07/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 WESTGATE AVE
SALEM IL
62881
US

IV. Provider business mailing address

101 S LOCUST ST
CENTRALIA IL
62801-3506
US

V. Phone/Fax

Practice location:
  • Phone: 618-548-2181
  • 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 Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GEORGIANNE BROUGHTON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 618-533-1391