Organization · Type 2 NPI
Community Residence, Inc.
Adult Care Home Facility · Licking, MO
NPI number
1275530776
Active
Practice location
225 W Highway 32
Licking, MO 65542-9832
Fax (573) 674-2239
Mailing address
312 Solley Dr, Rear
Ballwin, MO 63021-5248
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Adult Care Home Facility Primary | 311ZA0620X | 030734 (MO) |
Adult Care Home Facility: A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment.
Another provider at this address
About NPI 1275530776
Community Residence, Inc.'s National Provider Identifier is 1275530776, issued on Jun 30, 2005. The primary taxonomy on file is Adult Care Home Facility (311ZA0620X), and the practice location is in Licking, MO. The record was last updated on Jun 13, 2008.