Healthcare Provider Details

I. General information

NPI: 1669646584
Provider Name (Legal Business Name): COMMUNITY CARE RESOURCES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6717 STONE GLEN DRIVE
MIDDLETON WI
53562-3876
US

IV. Provider business mailing address

6717 STONE GLEN DRIVE
MIDDLETON WI
53562-3876
US

V. Phone/Fax

Practice location:
  • Phone: 608-827-7100
  • Fax: 608-827-7101
Mailing address:
  • Phone: 608-827-7100
  • Fax: 608-827-7101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number1220
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number180017
License Number StateWI

VIII. Authorized Official

Name: DANIEL J SIMON
Title or Position: EXECUTIVE DIRECTOR
Credential: MSSW
Phone: 608-827-7100