Organization
CCRI, INC
Active
Other names
Creative Care for Reaching Independence
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHANNON BOCK (EXECUTIVE DIRECTOR)
(218) 236-6730
Entity
Organization
Contact information
Practice address
2903 15TH ST S, MOORHEAD, MN 56560-5111
(218) 236-6730
(218) 236-1481
Mailing address
2903 15TH ST S, MOORHEAD, MN 56560-5111
(218) 236-6730
(218) 236-1481
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
MN
251S00000X
Community/Behavioral Health Agency
—
MN
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
MN
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
800502
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001418000
—
MN
05
—
304720200
—
MN
05
—
403445700
—
MN
05
—
409343700
—
MN
05
—
702420000
—
MN
Enumeration date
02/21/2007
Last updated
08/13/2014
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