Healthcare Provider Details

I. General information

NPI: 1053071639
Provider Name (Legal Business Name): THE COMMUNITY RESOURCE LINK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2021
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 EDEN WAY N
CHESAPEAKE VA
23320-2776
US

IV. Provider business mailing address

1021 EDEN WAY N
CHESAPEAKE VA
23320-2776
US

V. Phone/Fax

Practice location:
  • Phone: 434-203-9097
  • Fax: 757-937-6148
Mailing address:
  • Phone: 434-203-9097
  • Fax: 757-937-6148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. CHRISTIE FITZGERALD THAXTON
Title or Position: OWNER
Credential: REGISTERED NURSE
Phone: 434-203-9097