NPIMap

Organization Active NPI

Community Residence, Inc.

  • Adult Care Home Facility
  • Seneca, MO
National Provider Identifier
1376540872
Registry record updated Oct 30, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Care Home FacilityTaxonomy code 311ZA0620X
License
029629 Issued in MO
Legal business name
COMMUNITY RESIDENCE, INC.
Practice address
2400 Cherokee Ave
Seneca, MO 64865-9323
Phone
(417) 776-8053
Fax
(417) 776-1683
NPI assigned
Jun 30, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2007

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 029629 MO Primary

Addresses

Primary practice location

2400 Cherokee Ave
Seneca, MO 64865-9323

Mailing address

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

Other names 1

  • Seneca Home Place Doing business as

National Provider Directory

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

Other organizations with this tax ID 8

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

Locations

2400 Cherokee Ave
Seneca, MO 64865
Phone (417) 776-8053

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": "1193702400000",
    "number": "1376540872",
    "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": "2400 CHEROKEE AVE",
            "city": "SENECA",
            "state": "MO",
            "postal_code": "648659323",
            "telephone_number": "417-776-8053",
            "fax_number": "417-776-1683"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY RESIDENCE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-30",
        "last_updated": "2007-10-30",
        "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": "029629",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Seneca Home Place",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Seneca, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2007; 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.