CCRI INC NPI 1295870699

NPI Information

NPI: 1295870699
Provider Name: CCRI, INC

Doing Business As: CREATIVE CARE FOR REACHING INDEPENDENCE

Classification: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities - 320900000X
Entity Type: Organization
Address:
2903 15TH ST S
MOORHEAD, MN
ZIP 56560
Phone: (218) 236-6730
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CCRI, INC is a community based residential treatment facility, intellectual and/or developmental disabilities in Moorhead, MN. The provider is a home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. CCRI, INC NPI is 1295870699. The provider is registered as an organization entity type.
The provider Is Doing Business As Creative Care For Reaching Independence.

The provider's business location address is:

2903 15TH ST S
MOORHEAD, MN
ZIP 56560-111
Phone: (218) 236-6730
Fax: (218) 236-1481

The provider's authorized official is Shannon Bock .
The authorized official title is Executive Director and has the following contact phone number (218) 236-6730.

The enumeration date for this NPI number is 2/21/2007 and was last updated on 8/13/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	251E00000X	Home Health			MINNESOTA	No
2	251S00000X	Community/Behavioral Health			MINNESOTA	No
3	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)		MINNESOTA	No
4	320900000X	Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities		800502	MINNESOTA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	409343700	MEDICAID	MINNESOTA
2	1295870699	MEDICARE PIN	MINNESOTA
3	304720200	MEDICAID	MINNESOTA
4	403445700	MEDICAID	MINNESOTA
5	702420000	MEDICAID	MINNESOTA
6	001418000	MEDICAID	MINNESOTA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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