Provider Demographics
NPI:1801664321
Name:JESSIE CRAWFORD RECOVERY CENTER, INC
Entity type:Organization
Organization Name:JESSIE CRAWFORD RECOVERY CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED PEER SUPPORT SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:HOFFMAN
Authorized Official - Last Name:MAKULUNI
Authorized Official - Suffix:
Authorized Official - Credentials:CPS
Authorized Official - Phone:608-241-4285
Mailing Address - Street 1:2801 INTERNATIONAL LN STE 205
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-3152
Mailing Address - Country:US
Mailing Address - Phone:608-241-4285
Mailing Address - Fax:
Practice Address - Street 1:2801 INTERNATIONAL LN STE 205
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-3152
Practice Address - Country:US
Practice Address - Phone:608-241-4285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-14
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty