Provider Demographics
NPI:1063749901
Name:CC RESOURCE GROUP
Entity type:Organization
Organization Name:CC RESOURCE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:T
Authorized Official - Last Name:MWANGI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-787-2895
Mailing Address - Street 1:400 W CUMMINGS PARK STE 1725
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-6579
Mailing Address - Country:US
Mailing Address - Phone:617-797-4904
Mailing Address - Fax:888-848-4075
Practice Address - Street 1:400 W CUMMINGS PARK STE 1725
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-6579
Practice Address - Country:US
Practice Address - Phone:617-797-4904
Practice Address - Fax:888-848-4075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-13
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA347C00000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAVC0000441732OtherSTATE OF MASSACHUSETTS VENDOR CODE