Provider Demographics
NPI:1689065781
Name:VETERANS & COMMUNITY RESOURCE CENTER CORP
Entity Type:Organization
Organization Name:VETERANS & COMMUNITY RESOURCE CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KENYA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-350-5388
Mailing Address - Street 1:2140 9TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-7134
Mailing Address - Country:US
Mailing Address - Phone:727-530-5388
Mailing Address - Fax:
Practice Address - Street 1:2140 9TH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-7134
Practice Address - Country:US
Practice Address - Phone:727-530-5388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-10
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No292200000XLaboratoriesDental Laboratory
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)