| Community Resource Center Inc. | |
|
904 E. Martin Luther King Drive Centralia IL 62801-6280 | |
| (618) 533-1391 | |
| (618) 533-0012 |
| Full Name | Community Resource Center Inc. |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 904 E. Martin Luther King Drive, Centralia, 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. 101 S Locust St Centralia IL 62801-3506 Ph: (618) 533-1391 | Community Resource Center Inc. 904 E. Martin Luther King Drive Centralia IL 62801-6280 Ph: (618) 533-1391 |
| NPI Number | 1518246776 |
|---|---|
| Provider Enumeration Date | 08/05/2011 |
| Last Update Date | 12/21/2021 |
| Certification Date | 11/12/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518246776 | NPI | - | NPPES |
| 04035 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 04035 (Illinois) | Primary |
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Community Resource Center Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 519 S Locust St, Centralia, IL 62801 Phone: 618-533-1391 Fax: 618-533-0012 | |
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