NPIMap

Organization Active NPI

Community Residence, Inc.

Doing business as Mt Vernon Residential Care

  • Adult Care Home Facility
  • Mount Vernon, MO
National Provider Identifier
1669479150
Registry record updated Oct 30, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Care Home FacilityTaxonomy code 311ZA0620X
License
029793 Issued in MO
Legal business name
COMMUNITY RESIDENCE, INC.
Doing business as
Mt Vernon Residential Care
Practice address
1425B S Landrum St
Mount Vernon, MO 65712-1912
Phone
(417) 466-3649
Fax
(417) 466-4909
NPI assigned
Jun 30, 2005
Last updated
Oct 30, 2007By the provider in NPPES
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 029793 MO Primary

Addresses

Primary practice location

1425B S Landrum St
Mount Vernon, MO 65712-1912

Mailing address

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

Other names 1

  • Mt Vernon 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

Other organizations with this tax ID 8

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

Locations

1425 S Landrum St
#B
Mount Vernon, MO 65712
Phone (417) 466-3649

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": "1669479150",
    "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": "1425B S LANDRUM ST",
            "city": "MOUNT VERNON",
            "state": "MO",
            "postal_code": "657121912",
            "telephone_number": "417-466-3649",
            "fax_number": "417-466-4909"
        }
    ],
    "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": "029793",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mt Vernon Residential Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Vernon, 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.