Provider Demographics
NPI:1477205417
Name:CRCORT MNGMT CORP
Entity Type:Organization
Organization Name:CRCORT MNGMT CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:YASHICA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-407-0031
Mailing Address - Street 1:9921 W OKEECHOBEE RD APT 121D
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-2131
Mailing Address - Country:US
Mailing Address - Phone:305-790-5326
Mailing Address - Fax:
Practice Address - Street 1:3100 S CONGRESS AVE STE 2
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-9051
Practice Address - Country:US
Practice Address - Phone:855-754-3210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center