1417095472 NPI number — CENTER FOR COMMUNITY RESOURCES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417095472 NPI number — CENTER FOR COMMUNITY RESOURCES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR COMMUNITY RESOURCES, INC.
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:
1417095472
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
127 S MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUTLER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16001-5935
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-431-0095
Provider Business Mailing Address Fax Number:
724-431-0099

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
212 - 214 SOUTH MAIN STREET
Provider Second Line Business Practice Location Address:
SUITE 625
Provider Business Practice Location Address City Name:
BUTLER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16001-5987
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-431-0095
Provider Business Practice Location Address Fax Number:
724-431-0099
Provider Enumeration Date:
02/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROBB
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
P
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
724-431-0095

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 442680 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1007491000013 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007491000033 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 497401 . This is a "VALUE BEHAVIORAL HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1007491000032 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007491000034 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007491000052 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007491000028 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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