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General NPI Number Information
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NPI Number | 1396820098
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Entity Type | Organization
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Legal Business Name | COMMUNITY RESIDENCES, INC
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 01/09/2018
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Provider Practice Location Address
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Address Line | 14160 NEWBROOK DR
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City | CHANTILLY
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State | VA
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Zip | 20151-2297
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Country | US
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Telephone | 703-842-2333
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Fax | 703-842-2311
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Provider Business Mailing Address
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Address Line | 14160 NEWBROOK DR
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City | CHANTILLY
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State | VA
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Zip | 20151-2297
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Country | US
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Telephone | 703-842-2333
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Fax | 703-842-2311
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Authorized Official
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Title or Position | VP OF ADMINISTRATION/CFO
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Name | MR. TERRY HURLEY
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Credential |
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Telephone | 703-842-2321
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 05801001, 05801003,
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License Number State | VA
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