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NPI Code Detail

MEDICARE: COMMUNITY RESIDENCE, INC.

MEDICARE: COMMUNITY RESIDENCE, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1311ZA0620XAdult Care Home Facility029972MO

General Provider Information

NPI Number : 1285631770
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMMUNITY RESIDENCE, INC.
Provider Business Mailing Address
First Line : 312 SOLLEY DR
Second Line : REAR
City : BALLWIN
State : MO
Zip : 63021-5248
Country : US
Telephone Number : 636-394-3000
Fax Number : 636-394-7713
Provider Business Practice Location Address
First Line : 1700B S HUDSON AVE
Second Line :
City : AURORA
State : MO
Zip : 65605-2717
Country : US
Telephone Number : 417-678-2169
Fax Number : 417-678-3156
Authorized Official
Title or Position : PRESIDENT
Name : JAMES GIARDINA
Credential :
Telephone Number : 636-394-3000
Provider Enumeration Date : 06/30/2005
Last Update Date : 10/30/2007

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