Ccri, Inc

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

800502 Issued in MN

Legal business name

CCRI, INC

Doing business as

Creative Care for Reaching Independence

Practice address

2903 15TH St S
Moorhead, MN 56560-5111

Phone

(218) 236-6730

Fax

(218) 236-1481

NPI assigned

Feb 21, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Shannon Bock

Title

Executive Director

Phone

(218) 236-6730

Specialties & licenses 4

Addresses

Other identifiers 5

Other names 1

• Creative Care for Reaching Independence Doing business as

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Patrick Lenertz, LICSW

  • Clinical Social Worker
  • Moorhead, MN
  • NPI 1285384925
  Medicare reassignment Care Compare group NPD
• Salome Dyane Hoff-McFarlane, MSW LCSW LGSW

  • Clinical Social Worker
  • Fargo, ND
  • NPI 1104929785

  MN

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407888000000",
    "number": "1295870699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2903 15TH ST S",
            "city": "MOORHEAD",
            "state": "MN",
            "postal_code": "565605111",
            "telephone_number": "218-236-6730",
            "fax_number": "218-236-1481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2903 15TH ST S",
            "city": "MOORHEAD",
            "state": "MN",
            "postal_code": "565605111",
            "telephone_number": "218-236-6730",
            "fax_number": "218-236-1481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CCRI, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-21",
        "last_updated": "2014-08-13",
        "status": "A",
        "authorized_official_last_name": "BOCK",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "218-236-6730",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "MN",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MN",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "MN",
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "MN",
            "license": "800502",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001418000",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "304720200",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "702420000",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "403445700",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "409343700",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Creative Care for Reaching Independence",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jenna Kay Carriveau
• Nancy E Carriveau, LPCC
• Makayla Rachel Cary
• Castle Rock Access LLC
• Rachel Cavaness
• Central Care LLC
• Century Express Care LLC
• Randy Cernik
• Hilda Cervantes Cardona
• Bethany Ann Chapman, MS, LADC, LSW

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Moorhead, MN
• Providers in Moorhead, MN by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2014; 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.