1063749901 NPI number — CC RESOURCE GROUP

Table of content: (NPI 1063749901)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063749901 NPI number — CC RESOURCE GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CC RESOURCE GROUP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063749901
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 W CUMMINGS PARK STE 1725
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOBURN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01801-6579
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-797-4904
Provider Business Mailing Address Fax Number:
888-848-4075

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 W CUMMINGS PARK STE 1725
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOBURN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01801-6579
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-797-4904
Provider Business Practice Location Address Fax Number:
888-848-4075
Provider Enumeration Date:
11/13/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MWANGI
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
T
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
888-787-2895

Provider Taxonomy Codes

  • Taxonomy code: 343900000X , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 347C00000X , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: VC0000441732 . This is a "STATE OF MASSACHUSETTS VENDOR CODE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".