Provider Demographics
NPI:1669646584
Name:COMMUNITY CARE RESOURCES INC
Entity Type:Organization
Organization Name:COMMUNITY CARE RESOURCES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:MSSW
Authorized Official - Phone:608-827-7100
Mailing Address - Street 1:6717 STONE GLEN DRIVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-3876
Mailing Address - Country:US
Mailing Address - Phone:608-827-7100
Mailing Address - Fax:608-827-7101
Practice Address - Street 1:6717 STONE GLEN DRIVE
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-3876
Practice Address - Country:US
Practice Address - Phone:608-827-7100
Practice Address - Fax:608-827-7101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1220251B00000X
WI180017253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No253J00000XAgenciesFoster Care Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42179100Medicaid