Community Resource Center Inc.
Organization Active NPI Substance Use Disorder Rehabilitation Clinic/Center · Carlyle, IL
NPI 1154599884 · NPPES record last updated Dec 17, 2021
Key facts
- NPI
- 1154599884
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X
- Legal business name
- COMMUNITY RESOURCE CENTER INC.
- Practice address
- 580 8TH St
Carlyle, IL 62231-1803 - Phone
- (618) 594-4581
- Fax
- (618) 533-0012
- NPI assigned
- Feb 15, 2008
- Organization subpart
- No
Authorized official
- Name
- Georgianne Broughton
- Title
- Executive Director
- Phone
- (618) 533-1391
Other NPIs on the same Medicare enrollment 6
Practitioners 9
-
Sarah Jo Dorr, MA
-
Jackie Ann Duplayee, MSW, LCSW
-
Todd Holsapple, MSW
-
Jack L Koch, L.C.P.C.
-
Sally Johonna Lindsay, LCSW
-
Joanna M Meinert, MHP, CRADC, MISA I
-
Jean Ann Nosbisch, M.S.
-
Dale H Spitler, L.C.S.W.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20051229000256 | IL | Part B Supplier - Clinic/Group Practice | 8224050638 |
Receives reassigned benefits from 5 practitioners 6 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Centralia, IL; Vandalia, IL; Salem, IL; Carlyle, IL |
National Provider Directory
Locations
580 8th St
Carlyle, IL 62231
Phone (618) 594-4581
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Substance Use Disorder Rehabilitation Clinic/Center | 261QR0405X | Yes |
Addresses
Primary practice location
580 8TH St
Carlyle, IL 62231-1803
Mailing address
904 E. Martin Luther King Drive
Centralia, IL 62801-3506
Phone (618) 533-1391
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| A-00235-0002-A | Other | IL | DHS LICENSE NUMBER |
| 6115207 | Other | IL | BLUE CROSS |
| A-00235-0003-A | Other | IL | DHS LICENSE NUMBER |
| A-00235-0004-A | Other | IL | DHS LICENSE NUMBER |
| 04035 | Medicaid | IL | |
| A-00235-0001-A | Other | IL | DHS LICENSE NUMBER |
Other providers in Carlyle, IL
- Carlyle Senior Living LLC
- Clarion Healing Center, LTD
- Clinton County
- Tyson Coffey
- James G Coleman
- Community Resource Center Inc.
- Seth Alan Crocker
- Rebekah L. Donnelly
- Sarah Jo Dorr
- Deanna Fae Ducomb
All providers in Carlyle, IL · Substance Use Disorder Rehabilitation Clinic/Center in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 17, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.