Organization
COMMUNITY RESOURCE CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGIANNE BROUGHTON LPHA, LCPC (EXECUTIVE DIRECTOR)
(618) 533-1391
Entity
Organization
Contact information
Practice address
315 WESTGATE, SALEM, IL 62881
(618) 548-2181
(618) 548-1035
Mailing address
904 E MARTIN LUTHER KING DRIVE, CENTRALIA, IL 62801-3058
(618) 533-1391
(618) 533-0012
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04035
—
IL
01
—
671700
MEDICARE
IL
Enumeration date
05/26/2009
Last updated
01/03/2020
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