COMMUNITY RESIDENCE, INC. (NPI# 1275530776) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275530776 |
| Entity Type | Organization |
| Organization Name | COMMUNITY RESIDENCE, INC. |
| Other Organization Name | LICKING RESIDENTIAL CARE |
| Practice Address |
225 W Highway 32 Licking MO 65542-9832 |
| Mailing Address |
312 Solley Dr Rear Ballwin MO 63021-5248 |
| Practice Telephone | 5736742207 |
| Practice Fax Number | 5736742239 |
| Mailing Telephone | 6363943000 |
| Mailing Fax Number | 6363947713 |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2008-06-13 |
| Authorized Official Name | JAMES GIARDINA (PRESIDENT) |
| Authorized Official Telephone | 6363943000 |
| Is Organization Subpart | Y |
| Parent Organization Name | COMMUNITY RESIDENCE, INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 311ZA0620X |
Custodial Care Facility Specialization: Adult Care Home |
030734 | MO | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 266178706 | 05 |
| Other Name | Type Code |
|---|---|
| Licking Residential Care | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033116520 | Community Residence, Inc. | Custodial Care Facility | 201 Fir Rd, Carl Junction, MO 64834-9222 | 2005-06-30 |
| 1679570170 | Community Residence, Inc. | Custodial Care Facility | 32 Highway, Boss, MO 65440 | 2005-06-30 |
| 1376540872 | Community Residence, Inc. | Custodial Care Facility | 2400 Cherokee Ave, Seneca, MO 64865-9323 | 2005-06-30 |
| 1669479150 | Community Residence, Inc. | Custodial Care Facility | 1425b S Landrum St, Mount Vernon, MO 65712-1912 | 2005-06-30 |
| 1285631770 | Community Residence, Inc. | Custodial Care Facility | 1700b S Hudson Ave, Aurora, MO 65605-2717 | 2005-06-30 |
| 1518964006 | Community Residence, Inc. | Custodial Care Facility | 1207 E Roosevelt St, Salem, MO 65560-9676 | 2005-06-30 |
| Street Address |
225 W HIGHWAY 32 |
| City | LICKING |
| State | MO |
| Zip Code | 65542-9832 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154766806 | Arlene J O'brien | Counselor | 15423 Mccloy Road, Licking, MO 65542 | 2013-05-08 |
| 1629639109 | Douglas County Public Health Services Group, Inc. | Family Medicine | 135 College Ave., Licking, MO 65542 | 2019-06-25 |
| 1487171930 | Mercy Pharmacy Services, LLC | Pharmacy | 101 N Main St, Po Box 125, Licking, MO 65542 | 2017-08-25 |
| 1912424607 | Licking No 1 LLC | Skilled Nursing Facility | 209 Hickory St, Licking, MO 65542 | 2017-08-24 |
| 1295115236 | Douglas A Crase | Family Medicine | 233 S Main St, Licking, MO 65542 | 2015-06-04 |
| 1447412770 | Texas County Memorial Hospital | Clinic/Center | 233 South Main Street, Licking, MO 65542 | 2008-06-27 |
| 1336336205 | Russell Mahmudul Huq | Emergency Medicine | 233 S Main St, Licking, MO 65542 | 2007-09-25 |
| 1790978765 | St. John's Physician & Clinic | Pharmacist | 101 North Main Street, Licking, MO 65542 | 2007-08-23 |
| 1457597924 | Natalie Martha Jeffery | Registered Nurse | 135 College Ave., Licking, MO 65542-0000 | 2009-01-05 |
| 1184600181 | Jeffrey Kenneth Blue | Physician Assistant | 233 S Main Street, Licking, MO 65542-0047 | 2005-12-21 |
| Find all providers in zip 65542 | ||||
| Taxonomy Code | 311ZA0620X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Custodial Care Facility |
| Specialization | Adult Care Home |
| A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. |
| Notes: [7/1/2003: new] |
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| 1851956247 | Care Enterprises, LLC | Custodial Care Facility | 2034 W College St, Springfield, MO 65806-1524 | 2019-05-01 |
| 1598256653 | Barbara's Precious Generations | Custodial Care Facility | 8604 E 87th St, Raytown, MO 64138-4401 | 2018-05-24 |
| 1275057291 | Love To Life | Custodial Care Facility | 8229 N Broadway, Saint Louis, MO 63147-2323 | 2017-08-01 |
| 1932650850 | Open With Arms LLC | Custodial Care Facility | 4308 Hollow Brook Ct, Florissant, MO 63034-2880 | 2016-10-14 |
| 1376092445 | Grace Consumer Directed Services LLC | Custodial Care Facility | 1600 Heritage Lndg Ste 202a, Saint Peters, MO 63303-8488 | 2016-09-29 |
| 1649726761 | Together Cds LLC | Custodial Care Facility | 917 Delaird Dr, Saint Louis, MO 63137-2717 | 2016-08-29 |
| 1245786631 | Horizon Cds Network LLC | Custodial Care Facility | 1655 Celerity Dr, Florissant, MO 63031-8810 | 2016-08-26 |
| 1053781443 | Vanessa Williams | Custodial Care Facility | 5757 Park Ln, Saint Louis, MO 63147-1019 | 2015-09-29 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.