MEDICARE: COMMUNITY RESOURCE DEVELOPMENT GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1497944680
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY RESOURCE DEVELOPMENT GROUP

Provider Business Mailing Address
First Line	:	1235 EAST BLVD STE 242
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28203-5870
Country	:	US
Telephone Number	:	704-756-3991
Fax Number	:

Provider Business Practice Location Address
First Line	:	1235 EAST BLVD STE 242
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28203-5870
Country	:	US
Telephone Number	:	704-756-3991
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. SABRINA A MACK
Credential	:	MSW/QP
Telephone Number	:	704-756-3991

Provider Enumeration Date	:	10/24/2007
Last Update Date	:	10/24/2007

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