Organization
COMMUNITY RESOURCE CENTER INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GEORGIANNE BROUGHTON (EXECUTIVE DIRECTOR)
(618) 533-1391
Entity
Organization
Contact information
Practice address
904 E. MARTIN LUTHER KING DRIVE, CENTRALIA, IL 62801-6280
(618) 533-1391
(618) 533-0012
Mailing address
101 S LOCUST ST, CENTRALIA, IL 62801-3506
(618) 533-1391
(618) 533-0012
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
04035
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04035
—
IL
Enumeration date
08/05/2011
Last updated
12/21/2021
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