Provider Demographics
NPI:1538988381
Name:JESSIE CRAWFORD RECOVERY CENTER, INC.
Entity type:Organization
Organization Name:JESSIE CRAWFORD RECOVERY CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-241-4285
Mailing Address - Street 1:131 CLARMAR DR
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-2664
Mailing Address - Country:US
Mailing Address - Phone:608-445-4886
Mailing Address - Fax:
Practice Address - Street 1:131 CLARMAR DR
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-2664
Practice Address - Country:US
Practice Address - Phone:608-445-4886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-08
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility