NPIMap

Organization Active NPI

Community Residences, Inc.

  • In Home Supportive Care Agency
  • Chantilly, VA
National Provider Identifier
1669920955
Registry record updated Sep 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
In Home Supportive Care AgencyTaxonomy code 253Z00000X
License
058-01-011 Issued in VA
Legal business name
COMMUNITY RESIDENCES, INC.
Practice address
14160 Newbrook Dr
Suite 100
Chantilly, VA 20151-2297
Phone
(703) 842-2327
Fax
(703) 842-2341
NPI assigned
Sep 14, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2016

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

Authorized official

Name
Ms. Mary Jayne Panek
Title
Project Director
Phone
(703) 842-2327

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
In Home Supportive Care Agency 253Z00000X 058-01-011 VA Primary

Addresses

Primary practice location

14160 Newbrook Dr
Suite 100
Chantilly, VA 20151-2297

Mailing address

14160 Newbrook Dr
Suite 100
Chantilly, VA 20151-2297
Phone (703) 842-2327

Other identifiers 2

IdentifierTypeStateIssuer
421561300MedicaidMD
5000045761MedicaidVA

National Provider Directory

National Provider Directory
Tax ID family
Community Residences Inc24 organizations share this tax ID, including this one

Other organizations with this tax ID 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1473811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473811200000",
    "number": "1669920955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14160 NEWBROOK DR",
            "address_2": "SUITE 100",
            "city": "CHANTILLY",
            "state": "VA",
            "postal_code": "201512297",
            "telephone_number": "703-842-2327",
            "fax_number": "703-842-2341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14160 NEWBROOK DR",
            "address_2": "SUITE 100",
            "city": "CHANTILLY",
            "state": "VA",
            "postal_code": "201512297",
            "telephone_number": "703-842-2327",
            "fax_number": "703-842-2341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY RESIDENCES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-14",
        "last_updated": "2016-09-14",
        "status": "A",
        "authorized_official_last_name": "PANEK",
        "authorized_official_first_name": "MARY JAYNE",
        "authorized_official_title_or_position": "PROJECT DIRECTOR",
        "authorized_official_telephone_number": "703-842-2327",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "VA",
            "license": "058-01-011",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "421561300",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5000045761",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chantilly, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2016; 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.