MEDICARE: COMMUNITY RESOURCE NETWORK OF FLORIDA, LLC

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	251C00000X	Developmentally Disabled Services Day Training Agency
2	253Z00000X	In Home Supportive Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912673492
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY RESOURCE NETWORK OF FLORIDA, LLC

Provider Business Mailing Address
First Line	:	12751 WORLD PLAZA LN
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-3989
Country	:	US
Telephone Number	:	239-415-7400
Fax Number	:	239-689-1922

Provider Business Practice Location Address
First Line	:	12751 WORLD PLAZA LN # 85
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-3989
Country	:	US
Telephone Number	:	239-415-7400
Fax Number	:	239-689-1922

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	LISA JEROME
Credential	:
Telephone Number	:	239-247-2041

Provider Enumeration Date	:	08/17/2021
Last Update Date	:	03/26/2026

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