Provider Demographics
NPI:1669618765
Name:COMMUNITY RESOURCE CONNECTIONS OF NORTH CAROLINA, LLC
Entity type:Organization
Organization Name:COMMUNITY RESOURCE CONNECTIONS OF NORTH CAROLINA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:ORAN
Authorized Official - Last Name:CRAVEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-225-5505
Mailing Address - Street 1:12404 KENDALL RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-8542
Mailing Address - Country:US
Mailing Address - Phone:919-225-5505
Mailing Address - Fax:
Practice Address - Street 1:12404 KENDALL RIDGE CT
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-8542
Practice Address - Country:US
Practice Address - Phone:919-225-5505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-21
Last Update Date:2008-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services