COMMUNITY RESIDENCE, INC. (NPI# 1669479150) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669479150 |
| Entity Type | Organization |
| Organization Name | COMMUNITY RESIDENCE, INC. |
| Other Organization Name | MT VERNON RESIDENTIAL CARE |
| Practice Address |
1425b S Landrum St Mount Vernon MO 65712-1912 |
| Mailing Address |
312 Solley Dr Rear Ballwin MO 63021-5248 |
| Practice Telephone | 4174663649 |
| Practice Fax Number | 4174664909 |
| Mailing Telephone | 6363943000 |
| Mailing Fax Number | 6363947713 |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2007-10-30 |
| 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 |
029793 | MO | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Mt Vernon 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 |
| 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 |
1425B S LANDRUM ST |
| City | MOUNT VERNON |
| State | MO |
| Zip Code | 65712-1912 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063992527 | Regional Services | Nurse Practitioner | 400 Mo-174, Mt Vernon, MO 65712 | 2018-08-15 |
| 1295044303 | Jeffrey Paul Leclair | Physician Assistant | 1011 South East Street, Mt. Vernon, MO 65712 | 2010-10-07 |
| 1912174327 | Three Rivers Hospice Inc | Hospice Care, Community Based | 631 N Spring Park Blvd, Mt Vernon, MO 65712 | 2008-05-14 |
| 1821274929 | Hearing Crafters of America Inc | Hearing Instrument Specialist | 708 E Mt Vernon Blvd, Mt Vernon, MO 65712 | 2008-01-18 |
| 1609957885 | Mount Vernon Eyecare Associates, LLC | Optometrist | 104 S Hickory, Mount Vernon, MO 65712 | 2006-10-17 |
| 1982700423 | Ronald E. Price | Dentist | 1050 Hayward Dr., Mt Vernon, MO 65712 | 2006-09-15 |
| 1144279829 | Mary Elisabeth Aslin | Speech-Language Pathologist | 600 N. Main, Missouri Rehabilitation Center, Mount Vernon, MO 65712 | 2006-05-09 |
| 1912986332 | Robert Gordon Mcafee | Psychiatry & Neurology | 600 N Main, Mount Vernon, MO 65712 | 2006-01-13 |
| 1477856805 | Eric Snow | Physical Therapist | 1600 S Hickory St, Mount Vernon, MO 65712 | 2010-12-07 |
| 1477567030 | Ricky Lavaughn Kime | Internal Medicine | 600 N Main St, Va Outpatient Clinic, Mount Venon, MO 65712 | 2006-07-28 |
| Find all providers in zip 65712 | ||||
| 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 |
|---|---|---|---|---|
| 1528428547 | J & K Adult Care Home | Custodial Care Facility | 233 S 5th Ave, Mount Vernon, NY 10550-3829 | 2016-03-03 |
| 1992172142 | Sean Hamil | Custodial Care Facility | 437 S 2nd Ave, Mount Vernon, NY 10550-2881 | 2015-08-24 |
| 1457561623 | Cascade Living Group | Custodial Care Facility | 3807 E College Way, Mount Vernon, WA 98273-9182 | 2007-05-23 |
| 1326110594 | Jjr Enterprises Inc | Custodial Care Facility | 2025 Broadway St Ste B, Mount Vernon, IL 62864-2935 | 2006-11-14 |
| 1306990601 | Shamrock Services, LLC | Custodial Care Facility | 4219 Lincolnshire Dr, Mount Vernon, IL 62864-2157 | 2007-01-23 |
| 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 | ||||
| City | MOUNT VERNON |
| Zip Code | 65712 |
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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.