| Community Resource Center Inc. | |
|
580 8th St Carlyle IL 62231-1803 | |
| (618) 594-4581 | |
| (618) 594-8482 |
| Full Name | Community Resource Center Inc. |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 580 8th St, Carlyle, Illinois |
| Authorized Official Name and Position | Georgianne Broughton (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6185331391 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Resource Center Inc. 904 E. Martin Luther King Drive Centralia IL 62801-3506 Ph: (618) 533-1391 | Community Resource Center Inc. 580 8th St Carlyle IL 62231-1803 Ph: (618) 594-4581 |
| NPI Number | 1538395793 |
|---|---|
| Provider Enumeration Date | 06/02/2009 |
| Last Update Date | 12/17/2021 |
| Certification Date | 11/12/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538395793 | NPI | - | NPPES |
| 671700 | Other | IL | MEDICARE |
| 04035 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |