NPIMap

Organization Active NPI

Community Residences, Inc

  • Intellectual Disabilities Intermediate Care Facility
  • Arlington, VA
National Provider Identifier
1972675908
Registry record updated Jan 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
05801001 Issued in VA
Legal business name
COMMUNITY RESIDENCES, INC
Practice address
807 North Jackson Street
Cri Jackson Street Icf
Arlington, VA 22201
Phone
(703) 842-2333
NPI assigned
Nov 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2018

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

Authorized official

Name
Terry William Hurley
Title
VP of Administration/Cfo
Phone
(703) 842-2321

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 05801001 VA Primary

Addresses

Primary practice location

807 North Jackson Street
Cri Jackson Street Icf
Arlington, VA 22201

Mailing address

14160 Newbrook Dr
Chantilly, VA 20151-2297
Phone (703) 842-2333

Other identifiers 1

IdentifierTypeStateIssuer
010144833MedicaidVA

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": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1515456000000",
    "number": "1972675908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14160 NEWBROOK DR",
            "city": "CHANTILLY",
            "state": "VA",
            "postal_code": "201512297",
            "telephone_number": "703-842-2333",
            "fax_number": "703-842-2311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "807 NORTH JACKSON STREET",
            "address_2": "CRI JACKSON STREET ICF",
            "city": "ARLINGTON",
            "state": "VA",
            "postal_code": "22201",
            "telephone_number": "703-842-2333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY RESIDENCES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2018-01-09",
        "status": "A",
        "authorized_official_last_name": "HURLEY",
        "authorized_official_first_name": "TERRY",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "VP OF ADMINISTRATION/CFO",
        "authorized_official_telephone_number": "703-842-2321"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "VA",
            "license": "05801001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010144833",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Arlington, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2018; 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.