Organization
COMMUNITY RESOURCE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENISE DAUM (EXECUTIVE DIRECTOR)
(618) 533-1391
Entity
Organization
Contact information
Practice address
423 W MAIN, VANDALIA, IL 62471
(618) 283-4229
(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
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04035
—
IL
01
—
6115207
BLUE CROSS
IL
Enumeration date
02/15/2008
Last updated
02/15/2008
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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