NPIMap

Organization Active NPI

Community Residence, Inc.

Doing business as Licking Residential Care

  • Adult Care Home Facility
  • Licking, MO
National Provider Identifier
1275530776
Registry record updated Jun 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Care Home FacilityTaxonomy code 311ZA0620X
License
030734 Issued in MO
Legal business name
COMMUNITY RESIDENCE, INC.
Doing business as
Licking Residential Care
Practice address
225 W Highway 32
Licking, MO 65542-9832
Phone
(573) 674-2207
Fax
(573) 674-2239
NPI assigned
Jun 30, 2005
Last updated
Jun 13, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
COMMUNITY RESIDENCE, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 13, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
James Giardina
Title
President
Phone
(636) 394-3000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Care Home Facility 311ZA0620X 030734 MO Primary

Addresses

Primary practice location

225 W Highway 32
Licking, MO 65542-9832

Mailing address

312 Solley Dr
Rear
Ballwin, MO 63021-5248
Phone (636) 394-3000

Other identifiers 1

IdentifierTypeStateIssuer
266178706MedicaidMO

Other names 1

  • Licking Residential Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Community Residence Inc9 organizations share this tax ID, including this one
Part of
Community Residence Inc

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1120089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213315200000",
    "number": "1275530776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "312 SOLLEY DR",
            "address_2": "REAR",
            "city": "BALLWIN",
            "state": "MO",
            "postal_code": "630215248",
            "telephone_number": "636-394-3000",
            "fax_number": "636-394-7713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 W HIGHWAY 32",
            "city": "LICKING",
            "state": "MO",
            "postal_code": "655429832",
            "telephone_number": "573-674-2207",
            "fax_number": "573-674-2239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY RESIDENCE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMUNITY RESIDENCE, INC",
        "enumeration_date": "2005-06-30",
        "last_updated": "2008-06-13",
        "status": "A",
        "authorized_official_last_name": "GIARDINA",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "636-394-3000"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "MO",
            "license": "030734",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "266178706",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Licking Residential Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Licking, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.