NPIMap

Organization Active NPI

Community Resource Center Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Vandalia, IL
National Provider Identifier
1487822102
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
425 W Main St
Vandalia, IL 62471-2214
Phone
(618) 283-4229
Fax
(618) 533-0012
NPI assigned
Feb 15, 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

425 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 1

IdentifierTypeStateIssuer
04035MedicaidIL

National Provider Directory

National Provider Directory
Tax ID family
Community Resource Ctr 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.

NPI Registry JSON

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

{
    "created_epoch": "1203033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639699200000",
    "number": "1487822102",
    "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": "425 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": "2008-02-15",
        "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": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04035",
            "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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.