COMMUNITY RESIDENCE, INC. (NPI# 1518964006) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518964006 |
| Entity Type | Organization |
| Organization Name | COMMUNITY RESIDENCE, INC. |
| Other Organization Name | SALEM RESIDENTIAL CARE |
| Practice Address |
1207 E Roosevelt St Salem MO 65560-9676 |
| Mailing Address |
312 Solley Dr Rear Ballwin MO 63021-5248 |
| Practice Telephone | 5737299449 |
| Practice Fax Number | 5737298719 |
| Mailing Telephone | 6363943000 |
| Mailing Fax Number | 6363947713 |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | JAMES GIARDINA (PRESIDENT) |
| Authorized Official Telephone | 6363943000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 311ZA0620X |
Custodial Care Facility Specialization: Adult Care Home |
030959 | MO | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Salem 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 |
| 1275530776 | Community Residence, Inc. | Custodial Care Facility | 225 W Highway 32, Licking, MO 65542-9832 | 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 |
| Street Address |
1207 E ROOSEVELT ST |
| City | SALEM |
| State | MO |
| Zip Code | 65560-9676 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174087985 | Brenda Gott | Nurse Practitioner | 3103 Hh Highway, Salem, MO 65560 | 2019-01-25 |
| 1174959142 | Britney Nicole Christesen | Chiropractor | 909 S Pershing Ave, Salem, MO 65560 | 2013-09-22 |
| 1245550474 | Amber Nicole Duncan | Chiropractor | 803 W 32 Hwy, Suite B, Salem, MO 65560 | 2010-06-10 |
| 1043460371 | Tina Marie Mcmullin | Counselor | 601 East Center Street, Salem, MO 65560 | 2008-09-23 |
| 1225286347 | Craig Tatom | Nurse Practitioner | Hwy 72 N Physicians Office Building II, Salem, MO 65560 | 2008-09-03 |
| 1114190576 | Jamie Johnston Wilson | Registered Nurse | Hwy 72 West, Salem, MO 65560 | 2008-04-08 |
| 1750589024 | Vicky L Gulley | Emergency Medicine | 35629 Hwy 72, Pob 1, Suite 3, Salem, MO 65560 | 2007-07-06 |
| 1275669533 | Complete Care, Inc | Durable Medical Equipment & Medical Supplies | 116 W. 4th, Salem, MO 65560 | 2007-02-23 |
| 1023083722 | Brent K. Caudill | General Practice | Hwy 72 N, Salem, MO 65560 | 2006-02-17 |
| 1750369369 | Charles W Cunningham | Family Medicine | 1010 E Scenic Rivers Blvd, Salem, MO 65560 | 2006-01-04 |
| Find all providers in zip 65560 | ||||
| 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] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932647211 | Lynn Marie Bartlett | Custodial Care Facility | 4286 Camellia Dr S, Salem, OR 97302-2710 | 2017-02-07 |
| 1033514658 | Adult Care Center of Roanoke Valley Inc. | Custodial Care Facility | 2321 Roanoke Blvd, Salem, VA 24153-6456 | 2014-10-24 |
| 1114276029 | Covenant Care Services, LLC | Custodial Care Facility | 407 E 4th St, Salem, MO 65560-1547 | 2012-09-06 |
| 1679615330 | Stay Well Ahdc, Inc. | Custodial Care Facility | 45 Congress St, Salem, MA 01970-5579 | 2007-02-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932732690 | Mingo Residential Care of Puxico LLC | Custodial Care Facility | 24080 State Highway 51, Puxico, MO 63960-8114 | 2020-02-20 |
| 1578107298 | Heart Core LLC | Custodial Care Facility | 810 Kennedy Dr, Warsaw, MO 65355 | 2019-11-06 |
| 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.