NPIMap

Organization Active NPI

Community Resource Center Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Vandalia, IL
National Provider Identifier
1245408491
Registry record updated Dec 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
COMMUNITY RESOURCE CENTER INC.
Practice address
421 W Main St
Vandalia, IL 62471-2214
Phone
(618) 283-4229
Fax
(618) 533-0012
NPI assigned
Feb 11, 2008
Last updated
Dec 17, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Georgianne Broughton
Title
Executive Director
Phone
(618) 533-1391

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU Primary

Addresses

Primary practice location

421 W Main St
Vandalia, IL 62471-2214

Mailing address

904 E. Martin Luther King Drive
Centralia, IL 62801-3506
Phone (618) 533-1391

Other identifiers 6

IdentifierTypeStateIssuer
6115207OtherILBLUE CROSS
A-00235-0004-AOtherILDHS LICENSE NUMBER
A-00235-0001-AOtherILDHS LICENSE NUMBER
A-00235-0003-AOtherILDHS LICENSE NUMBER
04035MedicaidIL
A-00235-0002-AOtherILDHS LICENSE NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Community Resource CNTR Inc14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

  • Tara Fleeman
    • Psychiatric/Mental Health Nurse Practitioner
    • Salem, IL
    • NPI 1124838065
    NPD

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1202688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639699200000",
    "number": "1245408491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "904 E. MARTIN LUTHER KING DRIVE",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "628013506",
            "telephone_number": "618-533-1391",
            "fax_number": "618-533-0012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "421 W MAIN ST",
            "city": "VANDALIA",
            "state": "IL",
            "postal_code": "624712214",
            "telephone_number": "618-283-4229",
            "fax_number": "618-533-0012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY RESOURCE CENTER INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-11",
        "last_updated": "2021-12-17",
        "certification_date": "2021-11-12",
        "status": "A",
        "authorized_official_last_name": "BROUGHTON",
        "authorized_official_first_name": "GEORGIANNE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "618-533-1391"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "6115207",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DHS LICENSE NUMBER",
            "identifier": "A-00235-0004-A",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DHS LICENSE NUMBER",
            "identifier": "A-00235-0001-A",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DHS LICENSE NUMBER",
            "identifier": "A-00235-0003-A",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04035",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DHS LICENSE NUMBER",
            "identifier": "A-00235-0002-A",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vandalia, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.