Healthcare Provider Details

I. General information

NPI: 1063749901
Provider Name (Legal Business Name): CC RESOURCE GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2009
Last Update Date: 11/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W CUMMINGS PARK STE 1725
WOBURN MA
01801-6579
US

IV. Provider business mailing address

400 W CUMMINGS PARK STE 1725
WOBURN MA
01801-6579
US

V. Phone/Fax

Practice location:
  • Phone: 617-797-4904
  • Fax: 888-848-4075
Mailing address:
  • Phone: 617-797-4904
  • Fax: 888-848-4075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateMA

VIII. Authorized Official

Name: MR. CHARLES T MWANGI
Title or Position: CEO
Credential:
Phone: 888-787-2895