Provider Demographics
NPI:1912673492
Name:COMMUNITY RESOURCE NETWORK OF FLORIDA, LLC
Entity Type:Organization
Organization Name:COMMUNITY RESOURCE NETWORK OF FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:JEROME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:392-247-2041
Mailing Address - Street 1:12751 WORLD PLAZA LN
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-3989
Mailing Address - Country:US
Mailing Address - Phone:239-415-7400
Mailing Address - Fax:239-689-1922
Practice Address - Street 1:12751 WORLD PLAZA LN
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3989
Practice Address - Country:US
Practice Address - Phone:239-415-7400
Practice Address - Fax:239-689-1922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104125200Medicaid