Community Resource Center Inc

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

COMMUNITY RESOURCE CENTER INC

Practice address

315 Westgate Ave
Salem, IL 62881

Phone

(618) 548-2181

Fax

(618) 533-0012

NPI assigned

Feb 15, 2008

Organization subpart

No

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

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Other NPIs on the same Medicare enrollment 6

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

• Community Resource Center Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Carlyle, IL
  • NPI 1154599884

  O20051229000256

  Same enrollment
• Community Resource Center Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Vandalia, IL
  • NPI 1245408491

  O20051229000256

  Same enrollment
• Community Resource Center Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Centralia, IL
  • NPI 1386605434

  O20051229000256

  Same enrollment
• Community Resource Center Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Carlyle, IL
  • NPI 1538395793

  O20051229000256

  Same enrollment
• Community Resource Center Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Centralia, IL
  • NPI 1629204888

  O20051229000256

  Same enrollment
• Community Resource Center, Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Salem, IL
  • NPI 1770718439

  O20051229000256

  Same enrollment

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

{
    "created_epoch": "1203033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531353600000",
    "number": "1932377652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 S LOCUST ST",
            "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": "315 WESTGATE AVE",
            "city": "SALEM",
            "state": "IL",
            "postal_code": "62881",
            "telephone_number": "618-548-2181",
            "fax_number": "618-533-0012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY RESOURCE CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-15",
        "last_updated": "2018-07-12",
        "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": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04035",
            "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": "BLUE CROSS",
            "identifier": "6115207",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DHS LICENSE NUMBER",
            "identifier": "A-00235-0003-A",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DHS LICENSE NUMBER",
            "identifier": "A-00235-0002-A",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DHS LICENSE NUMBER",
            "identifier": "A-00235-0004-A",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tracy Adele Caswell, APRN
• Quinn Kun Chen, DDS
• Kyle Allen Clark, D.M.D.
• Danielle Nichole Cole, RBT
• Community Care Systems, Inc.
• Community Resource Center, Inc
• Cottages at Salem, Inc.
• County of Marion
• County of Marion
• Crossroads Physician Corp

• All providers in Salem, IL
• Substance Use Disorder Rehabilitation Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2018; 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.